The Value Of GM Test Of Bronchoalveolar Lavage Fluid In The Early Diagnosis Of Invasive Pulmonary Aspergillosis

BackgroundThe clinical symptoms of invasive pulmonary aspergillosis(IPA)are not specific,which brings great difficulties to the diagnosis of the disease,leading to delayed treatment and poor prognosis.Therefore,the early diagnosis of Invasive Pulmonary aspergillosis(IPA)plays a very important role in the treatment of the disease and the prognosis of patients.At present,there are more and more researches on the detection of galactomannan(GM)in bronchoalveolar lavage fluid(BALF),and the detection of galactomannan(GM)improves the diagnosis of IPA patients.s efficiency.ObjectiveThe purpose of this study was to investigate the value of bronchoalveolar lavage fluid galactomannan in the early diagnosis of invasive pulmonary aspergillosis.MethodThe patients with pulmonary infection treated in the First Affiliated Hospital of Zhengzhou University from January 2018 to March 2019 were retrospectively analyzed,and their basic data,relevant auxiliary examination results and final clinical diagnosis were collected.The included subjects were divided into groups according to the medical history,physical examination and auxiliary examination results,and according to the 2007 edition of the Chinese Medical Association’s "Expert Consensus on Diagnosis and Treatment of Pulmonary Mycosis".There were 207 cases in the diagnosis group and 233 cases in the non-IPA group in the control group.The research case data were processed and analyzed,the relative diagnostic efficacy of the GM test in serum,bronchoalveolar lavage fluid,and the combined detection of the two specimens was calculated,and the receiver operator characteristic curve(ROC curve)was drawn.And calculate the area under the curve to explore the cut-off value(cut-off value)of the bronchoalveolar lavage fluid GM test.The gender,age,combined chronic underlying diseases and other related data of the experimental group and the control group were compared,and the risk factors of IPA were evaluated.Results1.General analysis of case group and control group:a total of 450 patients,217 confirmed and clinically diagnosed IPA patients were used as the case group(10 confirmed and 207 clinically diagnosed),and 233 patients with IPA were excluded as the control group;There were 277 males(61.6%)and 173 females(38.4%),with an average age of 56.3±17.2 years.2.Analysis of the results of neutrophils,C-reactive protein,and procalcitonin in the case group and control group:the neutrophil count in the case group was 7.52 ±6.3(× 109/L),and the C-reactive protein was 52.70±70.24(mg/dL).),procalcitonin 1.84±10.67(ng/mL);control group neutrophil count 5.63±3.64(× 109/L),C-reactive protein 30.60±51.03(mg/dL),procalcitonin 0.58±3.64(× 109/L)3.12(ng/mL).The neutrophil count and C-reactive protein in the case group were higher than those in the control group(P<0.05).3.Comparison of the detection results of serum G test,serum and BALF GM test between the two groups:the results of serum G test,serum and BALF GM in the case group were 140.66 ± 136.62,0.68±0.27,0.98±0.74,respectively,and the control group was 69.00±0.74 50.94,0.59±0.22,0.45±0.15,the case group was higher than the control group(P<0.05).4.Comparison of serum G test,serum and BALF GM test results between case group and control group when combined with different underlying diseases and special treatment measures:BALF GM test results in case group were higher than those in control group(P<0.05).5.At different turning points,the sensitivity,specificity,positive predictive value,and negative predictive value of the BALF GM test are higher than those of the serum GM test;the sensitivity and negative predictive value of the BALF and serum GM tests are higher when they are detected in parallel,while the specificity is higher when they are detected in series.Sex,positive predictive value is high.6.By drawing ROC curve analysis,the area under the curve of BALF GM test and serum GM test were 0.805(95%CI:0.763-0.847)and 0.596(95%CI:0.544-0.649)respectively,and the area under the curve of BALF>serum.According to the ROC curve,the cut-off value of the BALF GM test was 0.595,and the sensitivity,specificity,positive predictive value,and negative predictive value were 69.59%,82.83%,79.06%,and 74.52%,respectively.7.In the analysis of risk factors for invasive pulmonary aspergillosis,gender,age,chronic obstructive pulmonary disease(COPD),bronchiectasis,asthma,lung cancer,autoimmune diseases and other chronic underlying diseases were compared between the two groups.P>0.05,no statistical significance.However,the combination of type 2 diabetes mellitus,ICU admission,and low albumin level in the two groups were compared P<0.05,which was statistically significant,indicating that this may be a high-risk factor for IPA.Conclusion1.Bronchoalveolar lavage fluid GM test has higher diagnostic value for invasive pulmonary aspergillosis than serum.The combined detection of the two can reduce the rate of missed diagnosis and misdiagnosis.2.According to the ROC curve,the cut-off value of the BALF GM test was determined to be 0.595.