Contribution of Galactomannan Antigen Detection in BAL to the Diagnosis of Invasive Pulmonary Aspergillosis in Patients With Hematologic Malignancies
Contribution of Galactomannan Antigen Detection in BAL to the Diagnosis of Invasive Pulmonary Aspergillosis in Patients With Hematologic Malignancies
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DOI：
10.1378/chest.09-0701
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发表时间：
2010-02-01
期刊：
影响因子：
9.6
通讯作者：
Tazi, Abdellatif
中科院分区：
文献类型：
--
作者：
Bergeron, Anne;Belle, Antoine;Tazi, Abdellatif
背景：侵袭性肺曲霉菌病（IPA）诊断困难。血清中半乳甘露聚糖（GM）的检测有助于IPA的诊断。BAL中GM抗原的阳性检测也被提议作为IPA的标准，尽管尚未得到充分验证。我们的研究的目的是评估GM抗原检测在BAL诊断IPA的血液病patients.Methods：101例连续治疗血液系统恶性肿瘤患者进行了探讨，通过支气管镜检查和BAL新的肺浸润的贡献。使用酶联免疫吸附试验评价BAL液和血清样本中的GM，光密度指数>= 0.5视为阳性。呼吸道样本也检查了真菌的存在。结果：IPA wits诊断33例患者根据欧洲组织的研究和治疗癌症和真菌病研究），小组共识组标准（6个证明，23个可能，4个可能）。这33例患者中有19例BAL GM试验阳性，而3例无IPA的患者出现假阳性结果。BAL中GM检测的敏感性为57.6%（95%CI，40.8%~72.8%），特异性为95.6%（95%CI，87.8%~98.5%）。在19例BAL GM阳性的IPA患者中，15例血清GM试验也阳性。结论：支气管肺泡灌洗液中GM的检测是对血清GM检测和呼吸道标本真菌学评价的补充，有助于IPA的诊断。阳性GM BAL是33例研究患者中2例的唯一微生物学标准。胸部2010; 137（2）：410 - 415
Background: Invasive pulmonary aspergillosis (IPA) is difficult to diagnose. The detection of galactomannan (GM) in serum samples is useful for diagnosing IPA. A positive test for GM antigen in BAL has also been proposed as a criterion of IPA, although it has not been fully validated. The aim of our study was to evaluate the contribution of GM antigen detection in BAL to the diagnosis of IPA in hematologic patients.Methods: One hundred one consecutive patients treated for hematologic malignancy were explored by bronchoscopy and BAL for new pulmonary infiltrates. Both BAL fluid and serum samples were evaluated for GM using an enzyme-linked immunosorbent assay test, with an optical density index >= 0.5 considered positive. Respiratory samples were also examined for the presence of fungi.Results: IPA wits diagnosed in 33 patients according to European Organization for Research and Treatment of Cancer and Mycoses Stud), Group consensus group criteria (six proven, 23 probable, four possible). Nineteen of these 33 patients had a positive BAL GM test, whereas three patients without IPA had false-positive results. GM detection in BAL had a sensitivity of 57.6% (95% CI, 40.8%-72.8%) and a specificity of 95.6% (95% CI, 87.8%-98.5%). Among the 19 patients with IPA whose BAL was positive for GM, 15 also had a positive serum GM test. In 11 of these 19 patients, Aspergillus was identified in the respiratory samples.Conclusion: Detection of GM in BAL is complementary of serum GM testing and mycologic evaluation of the respiratory samples for the diagnosis of IPA. Positive GM BAL was the sole microbiologic criterion in two of 33 patients studied. CHEST 2010; 137(2):410-415