Value Of Bronchoalveolar Lavage Fluid Galactomannan Detection In In The Diagnosis Of Invasive Pulmonary Apergillosis By Using Endogenous Marker To Quantify The Dilution

Objective:At present,the Bronchoalveolar lavage fluid(BALF)of bronchoalveolar lavage(Galactomannan,BALF)has many studies on the detection of galactomannan(Galactomannan,GM),and has a high diagnostic efficiency,but it is susceptible to irrigation factors such as perfusion,lavage time and recovery rate of lavage fluid,and the specificity of BALF GM detection in different studies And the fluctuation range of sensitivity is larger.The purpose of this study was to investigate the value of internal standard BALF GM in IPA diagnosis.Methods:We prospectively collected the patients who had been admitted to the Respiratory Medicine for pulmonary disease and were highly suspected of IPA or IPA patients.Bronchoalveolar lavage was performed under chest imaging.The concentration of GM,albumin and urea nitrogen was detected in the lotion,and the serum albumin and urea nitrogen were measured and BALF fungus culture and microscopic examination and histopathological examination of percutaneous biopsye were performed.Histopathological specimens obtained by biopsy were performed routine pathological examination and histopathological specific examination of related fungal infections.According to the diagnostic basis of the European cancer research and treatment organization and the fungal research group,the subjects were divided into IPA,IPA,IPA and non IPA.The diagnosis of IPA and clinical diagnosis of IPA patients,the control group is non IPA patients,the same patient first lavage 40 ml as the 40 ml lavage group,that is,group 1,and then the same part of the lavage 40 ml as the 80 ml alveolar lavage group,that is,group 2 corresponding to group 2,The statistical method was used to analyze the false positive difference between the BALF GM values of the internal reference standard,the diagnostic efficiency of BALF GM detection in IPA and whether the beta lactam drugs caused the false positive of the BALF GM detection of the internal reference standard.Results:1.There were significant differences in BALF GM,albumin concentration and urea nitrogen concentration in different alveolar lavage groups,that is,statistically significant(P values were less than 0.05),and there was no significant difference between BALF GM of different alveolar lavage groups by urea nitrogen and albumin(P),that is,there was no statistically significant statistical significance(P The value is more than 0.05).2.There was no significant difference in BALF GM value between the case group and the control group,that is,there was no significant statistical significance(P value was more than 0.05),and the albumin-normalized BALF GM value was significantly different between the case group and the control group,that is,the statistical significance was statistically significant(P values were less than 0.05).3.The ROC curve analysis showed that when the albumin-normalized BALF GM value of the 40 ml alveolar lavage group was more than 7.55 as the boundary value,the diagnostic efficiency was the highest,and the sensitivity and specificity reached 76.9% and 96.4%,respectively.The diagnostic efficiency of 80 ml alveolar lavage was 84.6% and 89.3%,respectively,when the albumin-normalized BALF GM value was greater than 7.51.The albumin-normalized BALF GM value of the combined group was greater than 7.54,and the diagnostic efficiency was the highest,sensitivity and specificity were 76.9% and 96.4% respectively.4.The positive boundary value of of the albumin-normalized BALF GM was more than 7.55.In the control group,18 cases of beta lactam antibiotics were used,of which 7 cases(38.9%)of he albumin-normalized BALF GM > 7.55,and 27 cases without beta lactam antibiotics,1(2.37%)he albumin-normalized BALF GM > 7.55,and statistically significant difference in group two.(Fisher the exact test of p=0.004).Conclusions:The internal reference labeling of galactomannan in bronchoalveolar lavage fluid can eliminate the dilution effect of the lavage factors and improve the diagnostic efficiency of IPA in the bronchoalveolar lavage fluid.It is a good indicator for the early diagnosis of invasive pulmonary aspergillosis.It is of great significance in the clinic;beta lactam is of great significance.Antibiotics can cause false positive results of galactomannan detection in standardized bronchoalveolar lavage fluid,which should be noticed clinically.