Diagnostic Value And Prognostic Analysis Of Bronchalveolar Lavage Fluid GM Test In Invasive Pulmonary Aspergillosis

ObjectiveThe purpose of this study was to compare the diagnostic value of Alveolar lavage fluid GM test with serum GM test in invasive pulmonary aspergillosis,and to explore the correlation between GM test and prognosis of invasive pulmonary aspergillosis.Methods80 patients with pulmonary aspergillosis(including confirmed,clinically diagnosed and quasi-diagnosed)diagnosed in Linyi People's Hospital from November 2016 to October 2019 were enrolled into the experimental group.Given Standard Antifungal therapy and followed up for 12 weeks(or at the end of death);and 256 hospitalized patients with pulmonary aspergillosis in the same period as the control group.All inpatients completed bronchoscopy before treatment,and improved Alveolar lavage fluid and serum GM test.SPSS22.0 statistical software was used to process the data.Independent sample T test or ?2 test was used to compare the clinical data of normal distribution.The skewness distribution was expressed by M(p25-p75),and the comparison was analyzed by nonparametric rank sum test.The ROC curve was used to compare the best cut-off value of lung lavage fluid and serum GM test in the diagnosis of IPA.The correlation between GM and IPA in Alveolar lavage fluid was analyzed by univariate and multivariate Logistic regression analysis.Results1.A total of 336 patients were included in this study.including 80 patients(6 confirmed,34 clinically,40 to be diagnosed)in the experimental group,including 55 males,aged 20?88 years(mean age:59.40± 14.59),and 25 females,aged 22?90 years(mean age:62.30±15.30).There were 256 patients in the control group,including 177 males,aged 19?90 years,(mean age:56.85±15.95),and 79 females,aged 22?79 years,(mean age:53.19±13.26).There was no significant difference in sex and age between the experimental group and the Control Group(P>0.05).2.The GM values of serum and Alveolar lavage fluid were skewed and analyzed by nonparametric rank sum test.1)The results of serum GM test showed that the mean GM of the experimental group was 0.78.the median GM was 0.67 and the median GM of Control Group was 0.51,the median GM was 0.49.Mann-Whitney U Test:Z=4.779,P<0.01,the difference was statistically significant.2)The results of GM test of Alveolar lavage fluid showed that the mean GM of experimental group was 2.24,the median GM was 1.90 and the mean GM of Control Group was 1.04,the median GM was 0.69.Mann-Whitney U Test:Z=8.467,P<0.01,the difference was statistically significant.3)The results of GM test of experimental group showed that the mean GM of Alveolar lavage fluid was 2.24,the median was 1.90 and the mean GM of serum was 0.78,the median was 0.67.Mann-Whitney U Test:Z=8.330,P<0.01,the difference was statistically significant.3.The ROC curve of serum GM test showed that the best critical point was 0.61,the sensitivity was 60.0%,the specificity was 80.1%,the positive predictive value was 48.5%,the negative predictive value was 86.5%,and the area under the ROC curve was 0.677(95%CI:0.600-0.754).4.The ROC curve of BALF GM test showed that the best critical point was 1.12,the sensitivity was 82.5%,the specificity was 72.7%,the positive predictive value was 48.5%,the negative predictive value was 93.0%,and the area under the ROC curve was 0.814(95%Cl:0.762-0.866).5.The median number of the Alveolar lavage fluid GM test in the experimental group was 1.90,which was divided into two groups:GM<1.90 and GM?1.90,P=0.024<0.05.The difference was statistically significant.Multiple Logistic regression analysis showed that GM?1.90 in Alveolar lavage fluid was an independent risk factor for poor prognosis of IPA.Conclusions1.GM was elevated in most patients with invasive pulmonary aspergillosis,and the GM of Alveolar lavage fluid is higher than the serum.2.The best diagnostic value of serum GM test is 0.61,and that of Alveolar lavage fluid is 1.12,but the ROC curve of Alveolar lavage fluid is larger than that of serum.3.The GM value of bronchoalveolar lavage fluid is related to the severity of disease,which affects the prognosis,and the GM ? 1.90 is an independent risk factor for poor prognosis of IPA.