Objective To evaluate the diagnostic value of serum and bronchoalveolar lavage fluid(BALF) aspergillus galactomannan(GM) test for invasive aspergillosis (IA) in the patients with non-neutropenia (absolute neutrophil ＞ 0.5 ×109/L).Methods ELISA was used to quantitatively detect serum and BALF GM levels of 206 patients with clinically suspected IA in our hospital.Then the detection results and clinical characteristics were analyzed.According to the clinical medical records and referring to the standards of European Organization for Research and Treatment Cancer/Invasive Fungal Infections Cooperative Group and the United States Mycoses Study Group,Anti-infective American Society guidelines,these patients were divided into the diagnosis,clinical diagnosis,suspected diagnosis and non-IA groups.Then the sensitivity,specificity,positive predictive value and negative predictive value were analyzed.Results Among 206 cases of clinical high risk IA non-neutropenia,93 cases were positive in GM test,with the sensitivity of 89 ％,specificity of 83 ％,positive predictive value of 86 ％,negative predictive value of 91％,Youden index of 0.72 and diagnosis accordance rate of 78％;the levels of BALF GM in various groups were higher than those of serum,in the aspect of positive rate,the BALF GM positive rate was also higher than serum GM positive rate.The ROC curve in the diagnosis group and clinical diagnosis group was drawn,the area under the curve was 0.82.Conclusion GM has clinical significance for the early diagnosis of IA in the patients with non-neutropenia.%目的 评价血清及肺泡灌洗液(BALF)曲霉菌半乳甘露聚糖(GM)试验对非粒细胞缺乏(中性粒细胞绝对数＞0.5×109/L,简称非粒缺)患者侵袭性曲霉菌病(IA)的诊断价值.方法 应用酶联免疫吸附法对四川大学华西医院临床怀疑IA的206例非粒缺患者定量检测血清及肺泡灌洗液半乳甘露聚糖水平,将检测结果和临床特征进行分析.参照欧洲癌症研究和治疗组织/侵袭性真菌感染协作组和美国真菌病研究组标准、美国抗感染学会指南,将临床病例分为确诊、临床诊断、拟诊和非IA组;并分析其灵敏度、特异度、阳性预测值、阴性预测值.结果 临床高危IA非粒缺患者206例,其中GM试验阳性93例,灵敏度89％,特异度83％,阳性预测值86％,阴性预测值91％,约登指数为0.72,诊断符合率78％;各组肺泡灌洗液GM水平均高于血清GM水平,肺泡灌洗液GM阳性率亦高于血清GM阳性率;确诊组+临床诊断组绘制ROC曲线,曲线下面积为0.82.结论 GM对IA的非粒缺患者的早期诊断同样具有临床意义.
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