血清半乳甘露聚糖水平检测对COPD患者侵袭性肺曲霉菌感染的诊断价值

摘要

目的探究血清半乳甘露聚糖水平检测对慢性阻塞性肺疾病（COPD）患者侵袭性肺曲霉菌感染（IPA）的临床意义。方法选取42例具有IPA高危因素的COPD患者，采用回顾性诊断标准进行分组：COPD确诊IPA 组、COPD可疑IPA 组和COPD排除IPA 组，比较三组的血清半乳甘露聚糖吸光度值。以确诊和排除 IPA 的患者作为阳性和阴性病例，分析血清半乳甘露聚糖水平检测在不同阳性判断临界值下的灵敏度与特异度。结果按照回顾性标准，COPD确诊IPA 组有18例、COPD可疑IPA 组有12例、COPD排除IPA 组有12例。三组患者的吸光度值分别为：1.69±0.87、1.38±0.79和0.27±0.60。 COPD确诊IPA 组与COPD可疑IPA 组的吸光度值均高于COPD排除IPA 组，差异均有统计学意义（t分别=4.92、4.01，P均＜0.05），而COPD确诊IPA 组与COPD可疑IPA 组之间比较，差异无统计学意义（t=0.99，P＞0.05）。不同半乳甘露聚糖阳性界定值显示：当半乳甘露聚糖取0.7作为阳性界定值时，其对COPD合并 IPA 的诊断灵敏性、特异性、阳性预测值、阴性预测值分别为87.30%、96.50%、87.20%及96.50%。结论血清半乳甘露聚糖的检测对于COPD患者侵染肺曲霉菌感染有较好的检测诊断作用，但并不能有效的区分COPD患者合并IPA患者的诊断级数，并且当血清半乳甘露聚糖临界值为0.7时，对于COPD患者侵染肺曲霉菌感染有较高的诊断价值。%Objective To explore the diagnosis value of serum galactomannan for detecting invasive pulmonary as-pergillosis (IPA) in patients with chronic obstructive pulmonary disease (COPD). Methods A total of 42 COPD patients with risk factors for IPA were selected and divided into diagnosed IPA group, suspicious IPA group and excluded IPA group according to a retrospective diagnostic criteria. The absorbance values of three groups were compared. The patients of diagnosed IPA and excluded IPA were regarded as positive and negative cases, and sensitivity and specificity of serum galactomannan under different cut-off values were calculated. Results In all COPD patients, there were 18 cases of diag-nosed IPA, 12 cases of suspicious IPA and 12 cases of excluded IPA. The absorbance values of three groups of patients were 1.69±0.87, 1.38±0.79 and 0.27±0.60 respectively. The absorbance values of diagnosed IPA group and suspicious IPA group were significantly higher than excluded IPA group (t=4.92, 4.01, P<0.05) while the difference between diagnosed IPA group and suspicious IPA group was not statistically significant (t=0.99, P>0.05). Different positive cut-off values of galactomannan showed that the sensitivity, specificity, positive predictive value and negative predictive value of COPD combined with IPA were 87.30%, 96.50%, 87.20% and 96.50% when the positive cut-off values was 0.7. Conclusion Serum galactomannan detection play a good role in pulmonary aspergillosis infection in patients with COPD, but it cannot distinguish the diagnosis degree of COPD patients combined IPA effectively. When the cut-off value is 0.7, the serum galactomannan has high diagnostic value for detecting IPA.