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目的探讨血清半乳甘露聚糖(GM)检测在儿童侵袭性肺曲霉病(IPA)早期诊断的价值。方法 IPA高危患儿80例中,确诊IPA的3例、临床诊断20例和疑似患者25例作为IPA组,32例非IPA患者为非IPA组。以双抗体夹心ELISA检测血清GM浓度。结果 IPA组,GM检测的AI值为1.52±0.74,高于非IPA组的0.57±0.23(P<0.05)。GM测定AI值≥1为阳性时,GM诊断儿童IPA的敏感性为81.25%(39/48),特异性为93.75%(30/32),阳性预测值为95.12%(39/41),阴性预测值为76.92%(30/39)。GM测定AI值≥0.5为阳性时,GM诊断儿童IPA的敏感性为91.67%(44/48),特异性为75.00%(24/32),阳性预测值为84.62%(44/52),阴性预测值为85.71%(24/28)。结论血清GM试验对检测儿童IPA有一定的临床诊断价值。GM试验阳性界值对检测准确性影响较大,阳性界值为1.0时诊断敏感性及特异性较高。
Objective To investigate the value of serum galactomannan (GM) detection in early diagnosis of invasive pulmonary aspergillosis (IPA) in children. Methods Among 80 cases with high risk of IPA, 3 cases with confirmed IPA, 20 cases diagnosed and 25 cases suspected as IPA were included in the study. 32 cases of non-IPA were non-IPA. Serum GM concentration was measured by double antibody sandwich ELISA. Results The AI of IPA group and GM group was 1.52 ± 0.74, which was higher than that of non-IPA group (0.57 ± 0.23, P <0.05). The sensitivity and specificity of GM were 81.25% (39/48) and 93.75% (30/32), respectively, and the positive predictive value was 95.12% (39/41) when the AI value of GM was ≥1. The predicted value is 76.92% (30/39). The sensitivity and specificity of GM were 91.67% (44/48) and 75.00% (24/32), respectively. The positive predictive value was 84.62% (44/52) in GM children with AI value> 0.5. The predicted value is 85.71% (24/28). Conclusion Serum GM test has certain clinical value in detecting children’s IPA. The positive value of GM test has a great effect on the accuracy of the detection. The positive cutoff value of 1.0 is more sensitive and specific.