肺泡灌洗液中半乳甘露聚糖抗原检查在诊断肺部真菌感染中的应用
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摘要
目的:观察肺泡灌洗液(BALF)中半乳甘露聚糖抗原检查(GM试验)在诊断肺部真菌感染中的应用和价值。方法:选取92例肺部感染患者行支气管镜下肺泡灌洗,收集BALF行GM试验,并同时做外周血清GM试验和痰真菌培养。结果:发现BALF中的GM试验(阳性结果:检测值> 1)与肺部真菌感染的危险因素之间无差异(P>0. 05);与CT影像学(多发结节、多发浸润)、发热之间无差异(P> 0. 05)。BALF中GM试验与痰真菌培养结果有显著关联(P <0. 05),而血清中GM试验与痰真菌培养阳性结果无关联(P> 0. 05)。根据BALF中GM试验阳性结果选择肺部感染的抗真菌治疗,发现64. 2%患者抗真菌治疗有效。结论:BALF中GM试验检测结果可作为临床上肺部真菌感染一个较好的辅助诊断依据。
Objective: To observe the applied value of galactomannan antigen(GM) test in bronchoalveolar lavage fluid(BALF) in pulmonary fungal infection. Methods: Ninety-two patients with pulmonary infection were selected for bronchoscopic alveolar lavage,BALF was collected for GM test,and peripheral blood GM test and sputum fungal culture were performed simultaneously. Results: There was no significant correlation between GM test in BALF(positive result: detection value > 1) and risk factors of pulmonary fungal infection(P > 0. 05),and between GM test with CT imaging(multiple nodules,multiple infiltration) and fever(P > 0. 05). GM test in BALF was significantly correlated with sputum fungal culture(P < 0. 05),while GM test in serum was not correlated with sputum fungal culture(P > 0. 05). According to the positive results of GM test in BALF,64. 2% of patients with pulmonary infection were treated with antifungal therapy. Conclusion:GM test in BALF can provide a good auxiliary diagnostic basis for clinical pulmonary fungal infection.
Objective: To observe the applied value of galactomannan antigen(GM) test in bronchoalveolar lavage fluid(BALF) in pulmonary fungal infection. Methods: Ninety-two patients with pulmonary infection were selected for bronchoscopic alveolar lavage,BALF was collected for GM test,and peripheral blood GM test and sputum fungal culture were performed simultaneously. Results: There was no significant correlation between GM test in BALF(positive result: detection value > 1) and risk factors of pulmonary fungal infection(P > 0. 05),and between GM test with CT imaging(multiple nodules,multiple infiltration) and fever(P > 0. 05). GM test in BALF was significantly correlated with sputum fungal culture(P < 0. 05),while GM test in serum was not correlated with sputum fungal culture(P > 0. 05). According to the positive results of GM test in BALF,64. 2% of patients with pulmonary infection were treated with antifungal therapy. Conclusion:GM test in BALF can provide a good auxiliary diagnostic basis for clinical pulmonary fungal infection.
引文
1蔡映云,任涛,杨岚,等.肺真菌病的诊断和治疗进展[J].临床内科杂志,2010,18(5):328-329.
2中华医学会呼吸病学分会感染学组.肺真菌病诊断和治疗专家共识[J].中华结核和呼吸杂志,2007,30(11):821-834.
3 Grancini A,Orlandi A,Lunghi G,et al.Evaluation of real time PCRaspergillus spp.in bronchoalveolar lavage samples[J].New Microbiol,2018,41(1):67-70.
4 Wang Y,Li D,Qiao L,et al.Infant central nervous system aspergillosis with first-episode of intracranial hemorrhage:a case report[J].Medicine(Baltimore),2017,96(47):e8893.
5 White PL,Price JS,Posso RB,et al.An evaluation of the performance of the Dynamiker Fungus(1-3)-β-D-Glucan Assay to assist in the diagnosis of invasive aspergillosis,invasive candidiasis and Pneumocystis pneumonia[J].Med Mycol,2017,55(8):843-850.
6 Patterson TF,Thompson GR,Denning DW,et al.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.
7陈亚红,姚婉贞,王建丽,等.重症监护病房肺部真菌感染的诊断与治疗[J].中华结核和呼吸杂志,2014,27(3):197-200.
8 Savio J,Menon NR,Sudharma AR,et al.Galactomannan assay and invasive pulmonary aspergillosis-comparison of the test performance at an inhouse and the Kit Cut-off[J].J Clin Diagn Res,2016,10(8):DC01-4.
9 Johnson GL,Sarker SJ,Nannini F.Aspergillus-specific lateral-flow device and real-time PCR testing of bronchoalveolar lavage fluid:a combination biomarker approach for clinical diagnosis of invasive pulmonary aspergillosis[J].J Clin Microbiol,2015,53(7):2103-2018.
10 Ko JH,Peck KR,Lee JY,et al.Multiple myeloma as a major cause of false-positive galactomannan tests in adult patients with cancer[J].JInfect,2016,72(2):233-239.
11徐灵彬,熊洁,孙莉,等.老年慢性阻塞性肺疾病急性加重患者合并肺部真菌感染危险因素分析[J].中华医院感染杂志,2013,22(3):529-531.
2中华医学会呼吸病学分会感染学组.肺真菌病诊断和治疗专家共识[J].中华结核和呼吸杂志,2007,30(11):821-834.
3 Grancini A,Orlandi A,Lunghi G,et al.Evaluation of real time PCRaspergillus spp.in bronchoalveolar lavage samples[J].New Microbiol,2018,41(1):67-70.
4 Wang Y,Li D,Qiao L,et al.Infant central nervous system aspergillosis with first-episode of intracranial hemorrhage:a case report[J].Medicine(Baltimore),2017,96(47):e8893.
5 White PL,Price JS,Posso RB,et al.An evaluation of the performance of the Dynamiker Fungus(1-3)-β-D-Glucan Assay to assist in the diagnosis of invasive aspergillosis,invasive candidiasis and Pneumocystis pneumonia[J].Med Mycol,2017,55(8):843-850.
6 Patterson TF,Thompson GR,Denning DW,et al.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.
7陈亚红,姚婉贞,王建丽,等.重症监护病房肺部真菌感染的诊断与治疗[J].中华结核和呼吸杂志,2014,27(3):197-200.
8 Savio J,Menon NR,Sudharma AR,et al.Galactomannan assay and invasive pulmonary aspergillosis-comparison of the test performance at an inhouse and the Kit Cut-off[J].J Clin Diagn Res,2016,10(8):DC01-4.
9 Johnson GL,Sarker SJ,Nannini F.Aspergillus-specific lateral-flow device and real-time PCR testing of bronchoalveolar lavage fluid:a combination biomarker approach for clinical diagnosis of invasive pulmonary aspergillosis[J].J Clin Microbiol,2015,53(7):2103-2018.
10 Ko JH,Peck KR,Lee JY,et al.Multiple myeloma as a major cause of false-positive galactomannan tests in adult patients with cancer[J].JInfect,2016,72(2):233-239.
11徐灵彬,熊洁,孙莉,等.老年慢性阻塞性肺疾病急性加重患者合并肺部真菌感染危险因素分析[J].中华医院感染杂志,2013,22(3):529-531.