[1]吕丽娟.抗原抗体检测联合CT检查对非粒缺人群IPA的诊断价值分析[J].医学信息,2024,37(10):96-100.[doi:10.3969/j.issn.1006-1959.2024.10.019]
　LYU Li-juan.Diagnostic Value of Antigen Antibody Detection Combined with CT Examination for IPA in Non-neutropenic Population[J].Journal of Medical Information,2024,37(10):96-100.[doi:10.3969/j.issn.1006-1959.2024.10.019]
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抗原抗体检测联合CT检查对非粒缺人群IPA的诊断价值分析()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
37卷
期数:
2024年10期
页码:
96-100
栏目:
论著
出版日期:
2024-05-15

文章信息/Info

Title:
Diagnostic Value of Antigen Antibody Detection Combined with CT Examination for IPA in Non-neutropenic Population
文章编号:
1006-1959（2024）10-0096-05
作者:
吕丽娟
（天水市第二人民医院检验科，甘肃 天水 741020）
Author(s):
LYU Li-juan
(Department of Laboratory Medicine,Tianshui Second People’s Hospital,Tianshui 741020,Gansu,China)
关键词:
抗原; 抗体; CT; 侵袭性肺曲霉病; 联合检测
Keywords:
Antigen; Antibodies; CT; Invasive pulmonary aspergillosis; Combined detection
分类号:
R519
DOI:
10.3969/j.issn.1006-1959.2024.10.019
文献标志码:
A
摘要:
目的 探讨BALF液曲霉菌半乳甘露聚糖（BALF-GM）抗原、曲霉菌IgG抗体联合CT检查对非粒缺人群IPA的临床诊断价值。方法 选取2020年1月-2023年2月在本院诊治为疑似侵袭性肺曲霉病（IPA）的非粒缺患者143例。根据EORTC／MSG制定的诊断标准进行分组，其中确诊组11例、临床诊断组97例、拟诊组12例、排除曲霉菌感染组23例。分析BALF-GM、曲霉菌IgG抗体、CT检查、三种检测手段联合对非粒缺人群IPA诊断的灵敏度、特异度、AUC值、约登指数，同时绘制ROC曲线。比较经验性抗真菌治疗与未经验性抗真菌治疗患者BALF-GM水平。结果 BALF-GM、曲霉菌IgG抗体、CT检查、三种检测手段联合对非粒缺人群IPA灵敏度为87.96%、79.63%、86.11%、83.33%，特异度为91.30%、91.30%、65.22%、100.00%，AUC值为0.896、0.855、0.757、0.918，约登指数为0.793、0.709、0.513、0.833，经验性抗真菌治疗与未经验性抗真菌治疗患者BALF-GM水平比较，差异有统计学意义（P＜0.05）。结论 BALF-GM、曲霉菌IgG抗体联合CT检查可提高非粒缺人群IPA诊断特异性，但由于经验性抗真菌治疗患者BALF-GM检测灵敏度较低，三种检测手段联合适用于未经验性抗真菌治疗的非粒缺IPA患者，对于经验性抗真菌治疗患者，需要临床医生全面评估检测结果与患者临床症状后做出合理诊断。
Abstract:
Objective To investigate the clinical value of BALF-GM antigen, Aspergillus IgG antibody combined with CT examination in the diagnosis of IPA in non-neutropenic population.Methods A total of 143 non-neutropenic patients with suspected invasive pulmonary aspergillosis (IPA) were selected from January 2020 to February 2023 in our hospital. According to the diagnostic criteria established by EORTC/MSG, 11 cases were diagnosed, 97 cases were clinically diagnosed, 12 cases were suspected, and 23 cases were excluded from Aspergillus infection. The sensitivity, specificity, AUC value and Youden index of BALF-GM, Aspergillus IgG antibody, CT examination and the combination of three detection methods in the diagnosis of IPA in non-neutropenic population were analyzed, and the ROC curve was drawn. The levels of BALF-GM in patients with empirical antifungal therapy and those without empirical antifungal therapy were compared.Results The sensitivity of BALF-GM, Aspergillus IgG antibody, CT examination and the combination of the three detection methods to IPA in non-neutropenic population was 87.96%, 79.63%, 86.11% and 83.33%, respectively; the specificity was 91.30%, 91.30%, 65.22% and 100.00%, respectively; the AUC values were 0.896, 0.855, 0.757 and 0.918, respectively; the Youden index was 0.793, 0.709, 0.513 and 0.833, respectively. There was a statistically significant difference in BALF-GM levels between patients with empirical antifungal therapy and those without empirical antifungal therapy (P<0.05).Conclusion BALF-GM, Aspergillus IgG antibody combined with CT examination can improve the diagnostic specificity of IPA in non-neutropenic patients. However, due to the low sensitivity of BALF-GM detection in patients with empirical antifungal therapy, the combination of the three detection methods is suitable for non-neutropenic IPA patients without empirical antifungal therapy. For patients with empirical antifungal therapy, clinicians need to comprehensively evaluate the test results and clinical symptoms of patients to make a reasonable diagnosis.

参考文献/References:

[1]Bulpa P,Dive A,Sibille Y.Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease[J].Eur Respir J,2007,30(4):782-800.[2]Menzin J,Meyers JL,Friedman M.length of hospitalization, and costs associated with invasive fungal infections in high-risk patients[J].Am J Health Syst Pharm,2009,66(19):1711-1717.[3]Blot SI,Taccone FS,Van den Abeele AM,et al.A clinical algorithm to diagnose invasive pulmonary aspergillosis in critically ill patients[J].Am J Respir Crit Care Med,2012,186(1):56-64.[4]钟南山,叶枫.深部真菌感染:新的挑战与展望[J].中华结核和呼吸杂志,2006,29(5):289-290.[5]Morgan J,Wannemuehler KA,Marr KA.Incidence of invasive aspergillosis following hematopoietic stem cell and solid organ transplantation: interim results of a prospective multicenter surveillance program[J].Med Mycol,2005,43 Suppl 1:S49-S58.[6]Dai Z,Zhao H,Cai S.Invasive pulmonary aspergillosis in non-neutropenic patients with and without underlying disease: a single-centre retrospective analysis of 52 subjects[J].Respirology,2013,18(2):323-331.[7]Bassetti M,Peghin M.Challenges and Solution of Invasive Aspergillosis in Non-neutropenic Patients: A Review[J].Infect Dis Ther,2018,7(1):17-27.[8]Guarner J,Brandt ME.Histopathologic diagnosis of fungal infections in the 21st century[J].Clin Microbiol Rev,2011,24(2):247-280.[9]叶再挺,曹卓,潘炯伟,等.55例肺曲霉菌病的临床及 CT 表现分析[J].医学影像学杂志,2015,25(6):998-1001.[10]毛伍兵,李水连,陈其锋.非中性粒细胞缺乏患者侵袭性气管支气管肺曲露菌病初次CT表现[J].放射学实践，2018,33(7):679-682.[11]Cornillet A,Camus C,Nimubona S.Comparison of epidemiological, clinical, and biological features of invasive aspergillosis in neutropenic and nonneutropenic patients: a 6-year survey[J].Clin Infect Dis,2006,43(5):577-584.[12]Bassetti M,Peghin M,Vena A.Challenges and Solution of Invasive Aspergillosis in Non-neutropenic Patients: A Review[J].Infect Dis Ther,2018,7(1):17-27.[13]Patterson TF,Thompson GR 3rd,Denning DW.Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America[J].Clin Infect Dis,2016,63(4):e1-e60.[14]马明铭,李芳,杨慧,等.侵袭性真菌病患者病原学特点和危险因素分析[J].疑难病杂志,2015,14(3):239-242.[15]张成飞,翟甜甜,张岩钊.血清半乳甘露聚糖试验对非粒细胞缺乏患者侵袭性肺曲霉病的诊断价值评估及影响因素分析[J].中华医院感染学杂志,2018,28(9):1284-1287,1295.[16]张传明,曹泓宇,孙继德.血清和支气管肺泡灌洗液GM试验对非粒细胞缺乏患者不同类型肺曲霉病的诊断价值分析[J].中国真菌学杂志,2022,17(2):146-151.[17]陈理达,黄杰凤,林其昌.β内酰胺类抗生素对血清半乳甘露聚糖检测假阳性率的影响[J].中华老年医学杂志,2015,34(1):78-81.[18]Zhou W,Li H,Zhang Y.Diagnostic Value of Galactomannan Antigen Test in Serum and Bronchoalveolar Lavage Fluid Samples from Patients with Nonneutropenic Invasive Pulmonary Aspergillosis[J].J Clin Microbiol,2017,55(7):2153-2161.[19]周华,姚亚克,周建英.曲霉IgG/IgM在不同类型肺曲菌病中的价值[C]//2018年中华医学会呼吸病学年会呼吸与危重症医学2017-2018论文集.2018:387-391.[20]Hope WW,Walsh TJ,Denning DW.Laboratory diagnosis of invasive aspergillosis[J].Lancet Infect Dis,2005,5(10):609-622.[21]戴超,孙岩.肺曲霉菌病的分型CT诊断及鉴别诊断[J].包头医学院学报,2016,32(3):86-87．[22]韩卓婷,黄妹,林小菊.1,3-β-D葡聚糖检测与半乳甘露聚糖抗原检测试验诊断侵袭性真菌感染的临床价值分析[J].黑龙江医学,2021,45(19):2102-2103.

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更新日期/Last Update: 1900-01-01