| 刘冬平,黄丽雯.炎症指标联合支气管肺泡灌洗液半乳甘露聚糖抗原试验对慢性阻塞性肺疾病并发侵袭性肺曲霉菌病的诊断价值[J].安徽医药,2026,30(7):1376-1382. |
| 炎症指标联合支气管肺泡灌洗液半乳甘露聚糖抗原试验对慢性阻塞性肺疾病并发侵袭性肺曲霉菌病的诊断价值 |
| Complicated by invasive pulmonary aspergillosis. The diagnostic value of combining inflammatory markers with bronchoalveolar lavage fluid galactomannan test for chronic obstructive pulmonary disease |
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| DOI：10.3969/j.issn.1009-6469.2026.07.021 |
| 中文关键词: 侵袭性肺曲霉菌病 肺疾病，慢性阻塞性 支气管肺泡灌洗液 半乳甘露聚糖 肿瘤坏死因子 α |
| 英文关键词: Invasive pulmonary aspergillosis Pulmonary disease,chronic obstructive Bronchoalveolar lavage fluid Galactoman-nan Tumor necrosis factor α |
| 基金项目:湖北省中西医结合科研指导性项目( 2016Z-B13)；湖北省卫生健康委员会资助项目( WJ2019M257) |
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| 中文摘要: |
| 目的分析炎症指标联合支气管肺泡灌洗液( BALF)半乳甘露聚糖抗原(GM)试验对慢性阻塞性肺疾病( COPD)并发侵袭性肺曲霉菌病( IPA)的诊断价值。方法回顾性分析 2021年 1月至 2024年 1月于武汉科技大学附属天佑医院就诊的 COPD病人，收集病人的病历资料，按照是否合并侵袭性肺曲霉病为 IPA组和非 IPA组。比较两组病人的炎症指标，运用二元 logistic回归分析及受试者操作特征曲线( ROC曲线)的方法，探讨不同炎症指标与 BALF GM联合诊断 COPD并发 IPA的诊断价值。结果该研究纳入 144例病人，其中 IPA组 53例，非 IPA组 91例。 IPA组病人的白细胞计数［ 6.29(4.75，8.81)×109/L比 7.09(5.41，9.32)×109/L］、单核细胞 /淋巴细胞( MLR)［0.36(0.25，0.53)比 0.48(0.28，0.73)］、白细胞介素 -6(IL-6)［5.88(2.91，13.44)ng/L比 11.90(3.70，20.09)ng/L］、肿瘤坏死因子 α(TNF-α)［1.56(1.33，1.74)ng/L比 6.44(1.45，10.60)ng/L］均低于非 IPA组(均 P<0.05)， IPA组的 BALF GM试验［ 3.81(1.18，5.40)μg/L］高于非 IPA组［ 0.18(0.10，0.40)μg/L］(P<0.05)。二元 logistic回归分析结果显示， TNF-α是 COPD并发 IPA的独立危险因素( P<0.05)。 TNF-α、BALF GM及二者联合 BALF GM试验诊断 COPD并发 IPA的 ROC曲线下面积及其 95%CI分别为 0.70(0.62，0.77)0.83(0.76，0.89)、0.89(0.84，0.94)比较 TNF-α、BALF GM试验与二者联合诊断的曲线下面积，差值分别为 0.20、0.07(均 P<0.05)。结论 白细胞计数、 MLR、IL-6和TNF-α在诊断 COPD并发 IPA方面具有临床意义，其中 TNF-α是最重要的炎症因子。 TNF-α与 BALF GM联合进行诊断提高了诊断的灵敏度和特异度，其诊断价值高于二者单独诊断时。 |
| 英文摘要: |
| Objective To analyze the diagnostic value of inflammatory markers combined with bronchoalveolar lavage fluid (BALF)galactomannan (GM) test in chronic obstructive pulmonary disease (COPD) complicated with invasive pulmonary aspergillosis (IPA).Methods Retrospective analysis was conducted on COPD patients who visited Tianyou Hospital Affiliated to Wuhan University ofScience and Technology from January 2021 to January 2024. Patient medical records were collected and divided into IPA and non-IPA groups based on the presence of IPA. A comparison of inflammatory markers between the two groups was performed using binary logis-tic regression analysis and receiver operating characteristic curve (ROC curve) plotting. The study aimed to explore the diagnostic valueof various inflammatory markers in combination with BALF GM for diagnosing COPD concurrent with IPA. Results This study in-volved 144 patients, with 53 in the IPA group and 91 in the non-IPA group. Patients in the IPA group exhibited lower levels of white blood cell count (WBC) [6.29 (4.75, 8.81) ×109/L vs. 7.09 (5.41, 9.32) ×109/L], monocyte to lymphocyte ratio (MLR) [0.36 (0.25, 0.53) vs. 0.48 (0.28, 0.73)], interleukin-6 (IL-6) [5.88 (2.91, 13.44) ng/L vs. 11.90 (3.70, 20.09) ng/L], and tumor necrosis factor-alpha (TNF-α) [1.56 (1.33, 1.74) ng/L vs. 6.44 (1.45, 10.60) ng/L] compared to those in the non-IPA group (all P < 0.05). The BALF GM test result in the IPA group [3.81 (1.18, 5.40) μg/L] was higher than that in the non-IPA group [0.18 (0.10, 0.40) μg/L] (P < 0.05). Binary logistic regression analysis identified TNF-α as an independent risk factor for COPD with IPA (P < 0.05). The areas under the ROC curves 95%CI for diagnosing COPD with IPA were 0.70 (0.62, 0.77) for TNF-α, 0.83 (0.76, 0.89) for BALF GM, and 0.89 (0.84, 0.94) for theircombination, with AUC differences of 0.20 and 0.07 respectively when comparing TNF-α, BALF GM, and their combination for diagno-sis (P < 0.05).Conclusions WBC, MLR, IL-6, and TNF-α are clinically significant in the diagnosis of COPD with concurrent IPA, with TNF-α emerging as the most crucial inflammatory factor. Combining TNF-α with BALF GM for diagnosis enhances its diagnosticvalue compared to individual assessments, thereby improving diagnostic sensitivity and specificity. |
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