王月　　刘子航　　王雪珍　　周永杰　　张丽

[摘要] 目的 探討曲霉特异性免疫球蛋白G（IgG）联合血清半乳甘露聚糖（GM）检测诊断慢性肺曲霉菌病（CPA）的临床参考价值，提高慢性肺曲霉菌病的诊断率。 方法 选取牡丹江医学院附属红旗医院自2018年12月至2019年12月疑似慢性肺曲霉菌病患者73例，并对患者确定诊断，采集患者血清测定曲霉特异性IgG、GM，应用ROC曲线分析曲霉特异性IgG、血清GM最佳临界值水平及对CPA的诊断价值。 结果 （1）73例患者诊断为慢性肺曲霉菌病者34例作为病例组，包括病理确定诊断8例、痰培养5例、BALF-GM测定15例，BALF培养6例，非慢性肺曲霉菌病者39例作为对照组，其均为非真菌感染。（2）CPA组曲霉特异性IgG、GM检测水平显著高于非CPA组（P<0.05）。（3）曲霉特异性IgG在91.77 AU/mL水平时所对应的约登指数最高（敏感度、特异度为64.7%、94.9%），血清GM在0.63 μg/L水平时所对应的约登指数最高（敏感度、特异度为38.2%、84.6%）。两种检测联合时敏感度增加至79.4%。（4）绘制ROC曲线得出，曲霉特异性IgG、血清GM检测工作特性曲线下的面积分别为0.801、0.635。两种检测联合工作特性曲线下的面积最大为0.846。 结论 曲霉特异性IgG联合血清GM检测可提高慢性曲霉菌病的诊断率。

[关键词] 曲霉特异性IgG;血清半乳甘露聚糖检测;慢性肺曲霉菌病;诊断价值

[中图分类号] R563          [文献标识码] A          [文章编号] 1673-9701（2021）11-0013-04

Diagnostic value of aspergillus specific IgG combined with serum galactomannan in chronic pulmonary aspergillosis

WANG Yue1   LIU Zihang1   WANG Xuezhen1   ZHOU Yongjie1   ZHANG Li2

1.Graduate School， Mudanjiang Medical University， Mudanjiang   157000， China; 2.Department of Respiratory and Critical Care Medicine， Hongqi Hospital Affiliated to Mudanjiang Medical University， Mudanjiang   157011， China

[Abstract]  Objective To explore the clinical reference value of aspergillus specific immunoglobulin G （IgG） combined with serum galactomannan （GM） in the diagnosis of chronic pulmonary aspergillosis （CPA） and to improve the diagnosis rate of CPA. Methods A total of 73 patients suspected of CPA were selected from the Medicine of Mudanjiang Hongqi Hospital from December 2018 to December 2019， and the diagnosis was confirmed. The serum of the patients was collected for Aspergillus specific IgG， GM， was used to analyze the Aspergillus specific IgG， the optimal critical value of serum GM and the diagnostic value of CPA by ROC curve. Results （1）There were 34 patients with chronic pulmonary aspergillosis as case group， including 8 patients with pathologically confirmed aspergillosis， 5 patients with sputum culture， 15 patients with BALF-GM test， 6 patients with BALF culture， and 39 patients without chronic pulmonary aspergillosis as control group， all of them were non-fungal infection. （2）The levels of Aspergillus specific IgG and GM in CPA group were significantly higher than those in non-CPA group. （3）The Jordan index of Aspergillus specific IgG at 91.77 AU/mL level was the highest （sensitivity and specificity were 64.7% and 94.9%）， and that of serum GM at 0.63 μg/L level was the highest （sensitivity and specificity were 38.2% and 84.6%）. When the two tests are combined， the sensitivity increases to 79.4%. （4）The area under the working characteristic curve of Aspergillus specific IgG and serum GM was 0.801 and 0.635 respectively by drawing ROC curve. The maximum area under the joint working characteristic curve of the two tests is 0.846. Conclusion Aspergillus specific IgG combined with serum GM detection can improve the diagnosis rate of chronic aspergillosis.

[Key words] Aspergillus specific IgG; Serum galactomannan detection; Chronic pulmonary aspergillus; Diagnostic value

曲霉菌病在临床中以各种形式存在，世界范围内的曲霉菌病患病率约为800万，其中慢性肺曲霉菌病（Chronic pulmonary aspergillus，CPA）达300万。据估计全世界300万CPA患者中，5年死亡率高达85%[1]，被认为是最难治的肺部感染性疾病之一。不能及时的对疾病做出正确诊断是导致CPA病死率高的原因之一[2]，所以早期快速诊断对疾病有重要作用，可及时控制病情，改善预后[3]，对慢性肺曲霉菌病的诊断提出了更多的挑战。

半乳甘露聚糖（Galactomannan，GM）检测可用于诊断曲霉菌感染[4-5]。有研究认为GM检测在侵袭性肺曲霉菌病中有重要作用[6-7]，但在CPA中诊断价值有限，仅25%左右的CPA 患者GM检测呈阳性[8-9]。近几年曲霉菌特异性抗体检测在国外逐渐应用于临床，但是国内关于曲霉菌特异性抗体检测的临床研究较少，曲霉特异性IgG联合血清GM检测是否能提高CPA诊断率国内尚无相关研究。……