Evaluation Of Early Diagnostic Value Of Galactomannann Antigen Test In Patients With Non-neutropenia Invasive Pulmonary Aspergillosis

Objectives:1.To evaluation the early diagnostic value of serum galactomannan(GM test)for patients with non-granulocyte-invasive pulmonary aspergillosis(IPA),and to obtain the best GM cut-off value and to screen for false positives and false results.Interference factors for negative results.2.To evaluation the early diagnostic value of bronchoalveolar lavage galactomannan(BALF GM test)in patients with chronic obstructive pulmonary disease(COPD)complicated with non-granulocyte-invasive pulmonary aspergillosis(IPA).Obtain the best GM cutoff value and screen out the interference factors that cause false positive and false negative results.3.To investigate the expression of neutrophil surface co-stimulatory molecules CD28,CD40,CD86,PD-1 and PD-L1 in patients with non-neutropenia IPA infection,and to explore their detection with serum GM and neutrophils.Whether the quantity is relevant.Method:1.Collect all non-neutropenia patients with serum GM values >0.5 in the inpatient department of the First Affiliated Hospital of Nanchang University from January 2016 to January 2019.The complete clinical data of these patients were retrospectively analyzed.Cases of agranulocytosis,chronic pulmonary aspergillosis,and no definitive diagnosis were excluded.According to the literature method,the remaining cases were divided into IPA group and non-IPA group.The serum GM value of the patients was detected by ELISA double antibody sandwich method.The statistical analysis of the data was performed by SPSS21.0 and the characteristic ROC curves were drawn.The diagnosis of different breakpoints was analyzed,and the optimal cutoff value was selected according to the maximum value of the Jordan index.Interference factors for false positive and false negative results,judging the source of the interference and the cause2.Collect all non-neutropenia patients with serum GM values >0.5 in theinpatient department of the First Affiliated Hospital of Nanchang University from January 2016 to January 2019.The complete clinical data of these patients were retrospectively analyzed.Cases of agranulocytosis,chronic pulmonary aspergillosis,and no definitive diagnosis were excluded.According to the literature method,the remaining cases were divided into IPA group and non-IPA group.The ELISA double antibody sandwich method was used to detect the ABLF GM value of the patient.The statistical analysis of the data was performed by SPSS21.0 and the characteristic ROC curve was drawn.The diagnosis of different vertices was analyzed,and the optimal cutoff value was selected according to the maximum value of the Jordan index.The interference factors of false positive and false negative results determine the source of the interference and the cause.3.Collect all non-neutropenia patients with serum GM values >0.5 in the inpatient department of the First Affiliated Hospital of Nanchang University from January 2016 to September 2016,and retrospectively analyze the complete clinical data of these patients.Cases of agranulocytosis,chronic pulmonary aspergillosis,and no definitive diagnosis were excluded.According to the literature method,the remaining cases were divided into IPA group and non-IPA group.Twenty patients were selected as outpatient health checkups as healthy controls.Flow cytometry was used to detect and analyze the expression of neutrophil surface CD molecules in each group of patients and healthy controls.The differences of neutrophil surface co-stimulatory molecules in IPA,non-IPA and healthy controls were analyzed.And to explore whether it is related to serum GM values and the number of neutrophils.Result:1.The serum GM value of 0.9 was the best cut-off value.The sensitivity,specificity,positive predictive value and negative predictive value of the diagnosis of non-neutropenia IPA infection were 60.4%,78.8%,55.2%,and 82.2%,respectively.The area under the characteristic ROC curve is 0.697.The GM false positive value caused by infectious interference factors was significantly higher than the GM false positive value caused by other causes,while the false negative results were caused by the use of antifungal drugs before the test.2.BALF GM value 0.88 is the best cutoff value.The sensitivity,specificity,positive predictive value and negative predictive value of COPD concurrent IPA diagnosis are 90.91%,85.42%,55.56%,97.56%,and the area under the ROC curve is0.882.The GM false positive value caused by infectious interference factors was significantly higher than the GM false positive value caused by other causes,while the false negative results were caused by the use of antifungal drugs before the test.3.The expression of CD40 and PD-1 in neutrophils was significantly lower in IPA group than in healthy control group(P <0.05),and statistically significant,while the expression of PDL-1 in neutrophils was significantly increased(P <0.05),statistically significant,while the expression of CD28 and CD86 was P>0.05,no statistical difference;the expression of CD28,CD40,CD86 and PD-1 in neutrophils was significantly lower in non-IPA group compared with healthy control group.(P<0.05),there was a statistical difference,and the expression of PDL-1 was significantly increased in neutrophil results(P<0.05),which was statistically significant.4.Compared with the non-IPA group,the expression of CD86 was signific-antly lower in the IPA group than in the non-IPA group(p<0.05).There was no significant difference in the expression of CD28,CD40,PD-1 and PDL1 in neutrophils(P>0.05).Conclusions:1.In patients with non-neutropenia IPA infection,the serum GM test selected0.9 as its optimal cut-off value.At this time,the sensitivity and specificity were60.4% and 78.8%,respectively.2.In patients with non-neutropenia IPA infection,the optimal cut-off value of BALF GM test was 0.8,and the sensitivity and specificity were 90.91% and 85.42%,respectively.The sensitivity and specificity of the BALF GM test is superior to the serum GM test.3.The false positive results of the GM test are mainly caused by the cross-reaction of other strains and the use of semi-synthetic penicillin,and the former is significantly higher than the latter,which is helpful for differential diagnosis;while the false negative results are mainly caused by pre-test prevention or treatment.Caused by the use of sexual antifungal drugs.4.When the serum GM test was abnormally elevated,the expression of CD molecules on the surface of neutrophils was disordered,and the expressions of CD40 and PD-1 were lower than those of healthy controls,while the expression of PD-L1 was higher than that of healthy controls.The expression of CD86 on the neutrophil surface in the IPA group was significantly lower than that in the non-IPA group.CD86 can be used to distinguish between IPA and non-IPA.5.The serum GM value of the IPA group was significantly higher than that of the non-IPA group,and there was a certain correlation with the expression of CD86 on the neutrophil surface.The number of neutrophils was not statistically different between the IPA group and the non-IPA group.