文章摘要
刘冬平.炎症指标联合支气管肺泡灌洗液GM实验对COPD并发IPA的诊断价值[J].安徽医药,待发表.
炎症指标联合支气管肺泡灌洗液GM实验对COPD并发IPA的诊断价值
投稿时间:2024-05-20  录用日期:2024-06-24
DOI:
中文关键词: 支气管肺泡灌洗液  半乳甘露聚糖  侵袭性肺曲霉菌病  慢性阻塞性肺疾病  炎症指标
英文关键词: 
基金项目:湖北省卫生健康委科研课题
作者单位邮编
刘冬平* 武汉科技大学附属天佑医院 430064
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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(GM)实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月于我院就诊的COPD患者,收集患者的病历资料,按照是否合并侵袭性肺曲霉病为IPA组和非IPA组。比较两组患者的炎症指标,运用二元logistic回归分析及绘制受试者工作特征(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:本研究纳入144例患者,其中IPA组53例,非IPA组91例。IPA组患者的白细胞计数(WBC)、单核细胞/淋巴细胞(MLR)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)均低于非IPA组(Z值分别为1.970、2.146、2.591、3.991,P均<0.05),IPA组的BALF GM实验高于非IPA组(Z值为-7.741,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实验诊断COPD并发IPA的ROC曲线下面积分别为0.700、0.830、0.889,比较TNF-α、BALF GM实验与二者联合诊断的AUC,差值分别为0.200、0.070(Z值分别为4.716、2.472,P均<0.05)。 结论:WBC、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。当TNF-α与BALF GM联合进行诊断时,其诊断价值高于二者单独诊断时,显著增加了诊断的特异性。
英文摘要:
      Objective Analyze the diagnostic value of inflammatory markers combined with bronchoalveolar lavage fluid (BALF) galactomannan (GM) test in COPD complicated with IPA. Methods Retrospective analysis was conducted on COPD patients who visited our hospital from January 2021 to January 2024. Patient medical records were collected and divided into IPA and non-IPA groups based on the presence of invasive pulmonary aspergillosis (IPA). A comparison of inflammatory markers between the two groups was performed using binary logistic regression analysis and receiver operating characteristic (ROC) curve plotting. The study aimed to explore the diagnostic value of various inflammatory markers in combination with BALF GM for diagnosing COPD concurrent with IPA. Results This study involved 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), monocyte to lymphocyte ratio (MLR), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) compared to those in the non-IPA group (Z=1.970, 2.146, 2.591, 3.991 respectively, all P < 0.05). The results of the BALF GM test showed higher values in the IPA group than in the non-IPA group (Z= -7.741, 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 for diagnosing COPD with IPA were 0.700 for TNF-α, 0.830 for BALF GM, and 0.889 for their combination, with AUC differences of 0.200 and 0.070 respectively when comparing TNF-α, BALF GM, and their combination for diagnosis (Z = 4.716, 2.472, P < 0.05). Conclusion WBC, MLR, IL-6, and TNF-α play a crucial role in the diagnosis of COPD with concurrent IPA, with TNF-α identified as the most important inflammatory factor. Combining TNF-α with BALF GM for diagnosis significantly improves diagnostic accuracy, surpassing the capabilities of each individual marker and notably enhancing diagnostic specificity.
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