CAJ | 학술논문

目的：探讨血清半乳甘露聚糖（GM）试验在侵袭性肺曲霉病（IPA）中的临床诊断价值。方法收集2010年3月至2011年3月期间中国医科大学附属第一医院及周边5所医院住院IPA高危患者共计103例，男60例（58.3%），女43例（41.7%），中位年龄51.90岁（18~86岁）。应用双夹心酶联免疫吸附法（ELISA）对疑诊患者的血清GM进行检测。结果所有入选患者中，确定诊断7例（6.8%），临床诊断19例（18.4%），拟诊40例（38.8%），排除IPA感染37例（36%）。以血清GM值单次>0.5为本次研究的界值，其敏感度、特异度、阳性预测值及阴性预测值分别为85.7%、86.5%、55%及97%，与拟诊组相比，GM检测对确诊组有更好的临床符合度。将入选患者分为粒缺组与非粒缺组时，GM检测的敏感性分别为74%与42%，在非粒缺患者中，GM试验对慢性肺部基础疾病并发IPA的诊断敏感性、特异性、阳性预测值及阴性预测值分别为71.4%、84.4%、66.75%及87.1%。以GM值0.5作为阳性界值，对可疑IPA患者给予抗曲霉菌治疗。与对照组相比，随着诊断级别的提高，拟诊组、临床诊断组及确诊组抗真菌治疗有效率逐渐降低，分别为70%、56%、40%。结论以GM值0.5作为阳性界值对IPA诊断有着良好的敏感性及特异性。GM试验在非粒缺合并慢性肺基础疾病的患者中诊断价值较高。GM试验与影像学检查、体液培养等传统检测方法相比，具有更高的敏感性及特异性，联合诊断能够提高IPA的临床诊断率。
목적：탐토혈청반유감로취당（GM）시험재침습성폐곡매병（IPA）중적림상진단개치。방법수집2010년3월지2011년3월기간중국의과대학부속제일의원급주변5소의원주원IPA고위환자공계103례，남60례（58.3%），녀43례（41.7%），중위년령51.90세（18~86세）。응용쌍협심매련면역흡부법（ELISA）대의진환자적혈청GM진행검측。결과소유입선환자중，학정진단7례（6.8%），림상진단19례（18.4%），의진40례（38.8%），배제IPA감염37례（36%）。이혈청GM치단차>0.5위본차연구적계치，기민감도、특이도、양성예측치급음성예측치분별위85.7%、86.5%、55%급97%，여의진조상비，GM검측대학진조유경호적림상부합도。장입선환자분위립결조여비립결조시，GM검측적민감성분별위74%여42%，재비립결환자중，GM시험대만성폐부기출질병병발IPA적진단민감성、특이성、양성예측치급음성예측치분별위71.4%、84.4%、66.75%급87.1%。이GM치0.5작위양성계치，대가의IPA환자급여항곡매균치료。여대조조상비，수착진단급별적제고，의진조、림상진단조급학진조항진균치료유효솔축점강저，분별위70%、56%、40%。결론이GM치0.5작위양성계치대IPA진단유착량호적민감성급특이성。GM시험재비립결합병만성폐기출질병적환자중진단개치교고。GM시험여영상학검사、체액배양등전통검측방법상비，구유경고적민감성급특이성，연합진단능구제고IPA적림상진단솔。
Objective To evaluate the value of serum galactomannan (GM) detection for invasive pulmonary aspergillosis (IPA) diagnosis. Methods The suspicious IPA patients were divided into proven,clinical and possible IPA groups. The patients excluded of IPA were recruited as controls. The serum GM concentration was detected by Platelia Aspergillus double?sandwich enzyme linked immunosorbent assay(ELISA). Re?sults In the 103 patients,there were seven cases diagnosed as proven,nineteen cases diagnosed as clinical and forty cases diagnosed as possible IPA patients. Setting 0.5 as the optimal result for GM detection,the sensitivity,specificity,positive predictive values and negative predictive values of GM were 85.7%,86.5%,55%and 97%,respectively. In non?neutropenia patients combinded with the pulmonary chronic diseases,the sensitivity, specificity,positive predictive values and negative predictive values of GM detection were 71.4%,84.4%,66.75%and 87.1%,respectively. Conclu?sion Index>0.5 for GM test could increase the sensitivity without obvious decreased specificity. GM detection could provide valuable information in patients of non?neutropenia underlying the pulmonary chronic diseases,which had a better sensitivity and specificity versus conventional diagnostic tests.