支气管肺泡灌洗液中的曲霉半乳甘露聚糖抗原用于诊断肺移植受者的侵袭性曲霉病。

Aspergillus galactomannan antigen in the bronchoalveolar lavage fluid for the diagnosis of invasive aspergillosis in lung transplant recipients.

作者信息

Husain Shahid, Paterson David L, Studer Sean M, Crespo Maria, Pilewski Joseph, Durkin Michelle, Wheat Joseph L, Johnson Bruce, McLaughlin Lisa, Bentsen Christopher, McCurry Kenneth R, Singh Nina

机构信息

Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, PA 15240, USA.

出版信息

Transplantation. 2007 May 27;83(10):1330-6. doi: 10.1097/01.tp.0000263992.41003.33.

DOI:10.1097/01.tp.0000263992.41003.33

PMID:17519782

Abstract

BACKGROUND

The clinical utility of Platelia Aspergillus enzyme immunoassay (EIA) for galactomannan (GM) antigen detection in bronchoalveolar lavage (BAL) for the diagnosis of invasive aspergillosis (IA) in lung transplant recipients is not known.

METHODS

BAL fluid samples from consecutive lung transplant recipients who underwent bronchoscopy were prospectively analyzed for GM.

RESULTS

A total of 333 BAL samples from 116 patients were tested. Invasive aspergillosis was documented in 5.2% (6/116) of the patients. Samples analyzed included 9 BALs from two patients with proven IA, 19 BALs from four patients with probable IA, and 305 BALs from 110 patients without IA. At the index cutoff value of > or =0.5, the sensitivity was 60%; specificity was 95%, with positive and negative likelihood ratios of 14 and 0.41, respectively. Increasing the index cutoff value to > or =1.0 yielded a sensitivity of 60%, a specificity of 98%, and the positive and negative likelihood ratios of 28 and 0.40, respectively. Two of six patients with IA receiving antifungal prophylaxis had false-negative results.

CONCLUSIONS

A Platelia EIA index cut-off > or =1.0 in the BAL fluid in a lung transplant recipient with a compatible clinical illness may be considered as suggestive of IA.

摘要

背景

尚不清楚用于检测支气管肺泡灌洗（BAL）中半乳甘露聚糖（GM）抗原的普立泰 Aspergillus 酶免疫测定（EIA）在肺移植受者侵袭性曲霉病（IA）诊断中的临床效用。

方法

对连续接受支气管镜检查的肺移植受者的 BAL 液样本进行前瞻性 GM 分析。

结果

共检测了 116 例患者的 333 份 BAL 样本。5.2%（6/116）的患者被记录为侵袭性曲霉病。分析的样本包括来自 2 例确诊 IA 患者的 9 份 BAL 样本、来自 4 例可能 IA 患者的 19 份 BAL 样本以及来自 110 例无 IA 患者的 305 份 BAL 样本。在指数临界值≥0.5 时，敏感性为 60%；特异性为 95%，阳性似然比和阴性似然比分别为 14 和 0.41。将指数临界值提高到≥1.0 时，敏感性为 60%，特异性为 98%，阳性似然比和阴性似然比分别为 28 和 0.40。6 例接受抗真菌预防的 IA 患者中有 2 例出现假阴性结果。