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目的评价血清半乳甘露聚糖(GM)检测对侵袭性肺曲霉病(IPA)的诊断价值。方法清洁级健康成年 SD 大鼠90只,按随机区组设计分为烟曲霉感染组、白假丝酵母菌感染组、毛霉感染组、肺炎链球菌感染组、烟曲霉口咽定植组,每组18只。气管插管滴入法建立大鼠侵袭性肺部真菌感染和细菌感染动物模型。经鼻腔和口咽滴入法建立烟曲霉口咽定植动物模型。分别于接种完成后第3天、第7天、第12天处死大鼠,取心脏血,采用 Platelia Aspergillus(法国 Bio-Rad 公司)试剂盒检测血清 GM,取肺组织行组织病理学检查。多组间比较采用单因素方差分析,实验数据经 SPSS 统计软件处理。结果除曲霉定植组外,光镜下各组大鼠肺组织均见明显炎症反应,真菌感染大鼠在肺组织中可见真菌菌丝或孢子。烟曲霉、白假丝酵母菌、毛霉、肺炎链球菌感染组和烟曲霉口咽定植组大鼠血清 GM 的吸光度指数均值分别为1.69±0.29、0.89±0.46、0.87±0.39、0.77±0.34和0.90±0.49,烟曲霉感染组与其他4组分别比较,差异明显。以吸光度指数为1.5作为诊断阈值诊断 IPA 的敏感性、特异性、阳性预测值和阴性预测值分别为78.6%、87.5%、57.9%和94.9%;以吸光度指数为1.5时,第3天、第7天和第12天血清 GM 检测诊断 IPA 的敏感性分别为60%、80%和100%。结论 GM 检测可区分 IPA 与白假丝酵母菌感染、毛霉感染、肺炎链球菌感染和烟曲霉口咽定植;GM 检测诊断 IPA的敏感性随感染时间的延长而增加;以吸光度指数为1.5作为诊断阈值诊断 IPA 的敏感性、特异性较理想。
Objective To evaluate the diagnostic value of serum galactomannan (GM) for invasive pulmonary aspergillosis (IPA). Methods Ninety healthy adult Sprague-Dawley rats were randomly divided into Aspergillus fumigatus infection group, Candida albicans infection group, Mucor infection group, Streptococcus pneumoniae infection group, Aspergillus fumigatus oropharyngeal colonization group, Group of 18. Establishment of an animal model of invasive pulmonary fungal infection and bacterial infection in rats by intratracheal intratracheal instillation. Establishment of animal models of oropharyngeal colonization of Aspergillus fumigatus by nasal and oropharyngeal instillation. The rats were sacrificed on the 3rd, 7th and 12th day after inoculation. Serum GM was determined by Platelia Aspergillus (Bio-Rad, France), and the histopathological examination was performed on the lungs. One-way analysis of variance (ANOVA) was used to compare multiple groups. The experimental data were processed by SPSS statistical software. Results In addition to Aspergillus colonization group, the lung tissue of rats in each group showed obvious inflammatory reaction under light microscope. Fungal mycelium or spores were found in lung tissue of fungal infected rats. Aspergillus fumigatus, Candida albicans, Mucor, Streptococcus pneumoniae infection group and Aspergillus fumigatus oropharyngeal colonization group, the mean GM values of serum GM were 1.69 ± 0.29,0.89 ± 0.46,0.87 ± 0.39,0.77 ± 0.34 and 0.90 ± 0.49, Aspergillus fumigatus infection group compared with the other four groups, the difference was significant. The sensitivity, specificity, positive predictive value and negative predictive value of IPA with diagnostic absorbance index of 1.5 were 78.6%, 87.5%, 57.9% and 94.9%, respectively. When the absorbance index was 1.5, The sensitivity of serum GM test on day 7 and 12 to diagnose IPA was 60%, 80% and 100%, respectively. Conclusion GM test can distinguish between IPA and Candida albicans infection, Mucor infection, Streptococcus pneumoniae infection and Aspergillus fumigatus colonization; The sensitivity of GM test to diagnose IPA increases with the extension of infection time; The absorbance index of 1.5 Diagnostic threshold diagnosis of IPA sensitivity, specificity is better.