Evaluation of Aspergillus-Specific Lateral-Flow Device Test Using Serum and Bronchoalveolar Lavage Fluid for Diagnosis of Chronic Pulmonary Aspergillosis
Evaluation of Aspergillus-Specific Lateral-Flow Device Test Using Serum and Bronchoalveolar Lavage Fluid for Diagnosis of Chronic Pulmonary Aspergillosis
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DOI：
10.1128/jcm.00095-19
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发表时间：
2019-05-01
影响因子：
9.4
通讯作者：
Izumikawa, Koichi
中科院分区：
文献类型：
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作者：
Takazono, Takahiro;Ito, Yuya;Izumikawa, Koichi
曲霉特异性侧流装置（AspLFD）测试是一种新开发的针对侵袭性肺曲霉病的即时诊断方法。然而，AspLFD诊断慢性肺曲霉病（CPA）的证据有限。因此，我们进行了一项回顾性研究，将其与半乳甘露聚糖(GM) β - d -葡聚糖（BDG）测试进行比较。50例慢性肺曲霉病患者和65例呼吸道疾病患者作为对照，纳入本研究。以慢性肺曲霉病为主（64.0%,n = 32），其次为亚急性侵袭性肺曲霉病（IPA） （20.0%, n = 10）和单纯性肺曲霉病（SPA） （16.0%, n = 8）。血清样品中AspLFD检测的敏感性和特异性分别为62.0%和67.7%。GM检测（截止指数为1.54）的敏感性为22%，特异性为92.3%；BDG检测（截止指数为19.3 pg/ml）的敏感性和特异性分别为48%和90.8%。在支气管肺泡灌洗液样本中，AspLFD检测的敏感性为66.7%，特异性为69.2%，而GM检测（截断指数为0.6）的敏感性为72.7%，特异性为83.1%。曲霉沉淀抗体试验敏感性为70%。与曲霉沉淀抗体试验不同，血清样品的AspLFD对非烟曲霉的敏感性相似。血清样本AspLFD假阳性的患者年龄明显高于阴性的对照组，且胸部计算机断层扫描中空洞病变的发生率也高于阴性的对照组。鉴于本研究的结果，使用血清的AspLFD作为诊断CPA的即时检测是可以接受的。
The Aspergillus-specific lateral-flow device (AspLFD) test is a newly developed point-of-care diagnostic method for invasive pulmonary aspergillosis. However, evidence of the diagnostic performance of the AspLFD for chronic pulmonary aspergillosis (CPA) is limited. Therefore, we conducted a retrospective study to investigate this in comparison with the galactomannan (GM) beta-D-glucan (BDG) test. Fifty patients with chronic pulmonary aspergillosis and 65 patients with respiratory disease, as a control, were enrolled in this study. The majority of the CPA disease entities were chronic pulmonary aspergillosis (64.0%, n = 32), followed by subacute invasive pulmonary aspergillosis (IPA) (20.0%, n = 10) and simple pulmonary aspergilloma (SPA) (16.0%, n = 8). The sensitivity and specificity of the AspLFD test in serum samples were 62.0% and 67.7%, respectively. The GM test (cutoff index, 1.54) showed a sensitivity of 22% and a specificity of 92.3%, while the sensitivity and specificity of the BDG test (cutoff, 19.3 pg/ml) were 48% and 90.8%, respectively. In bronchoalveolar lavage fluid samples, the AspLFD test showed a sensitivity of 66.7% and a specificity of 69.2%, while those of the GM test (cut-off index, 0.6) were 72.7% and 83.1%, respectively. The Aspergillus precipitating antibody test had 70% sensitivity. Unlike the Aspergillus precipitating antibody test, the AspLFD on serum samples showed similar sensitivity to non-fumigatus Aspergillus species. Patients with false-positive results for the AspLFD on serum samples were of a significantly higher age and had a higher prevalence of cavitary lesions in chest computed tomography than patients with negative results in the control group. Given the results in this study, the performance of the AspLFD using serum was acceptable as a point-of-care test for the diagnosis of CPA.