Diagnostic value of serum Aspergillus fumigatus immunoglobulin G combined with galactomannan antigen test in bronchoalveolar lavage fluid for chronic pulmonary aspergillosis
Objective To investigate the diagnostic value of serum Aspergillus fumigatus immunoglobulin G(IgG),bronchoalveolar lavage fluid(BALF)galactomannan antigen test(GM test)and combined detection of the two methods in chronic pulmonary aspergillosis(CPA).Methods A total of 310 patients with suspected CPA who were hospitalized in Wuhan Pulmonary Hospital from January 2020 to December 2022 were screened.BALF-GM test and serum Aspergillus fumigatus IgG were detected.According to the inclusion and exclusion criteria,151 confirmed or clinically diagnosed CPA patients were enrolled and 60 non-CPA cases were included as controls.The underlying diseases,clinical symptoms and imaging findings of the two groups were analyzed using case-control study.Statistical comparison was performed by chi-square test.The efficacies of BALF-GM test,serum Aspergillus fumigatus IgG test,and their combined detection for CPA were analyzed by receiver operating characteristic curve.Results There were 130 confirmed cases and 21 clinically diagnosed cases among 151 patients with CPA,including 106 males(70.2％)with age of(54.6±15.5)years.The age of 60 non-CPA patients was(53.6±17.8)years,including 42 males(70.0％).The proportions of pulmonary tuberculosis,bronchiectasis and chronic obstructive pulmonary disease,and the incidence of hemoptysis in CPA group were 79.47％(120/151),86.09％(130/151),26.49％(40/151)and 43.71％(66/151),respectively,which were all higher than those in non-CPA group(10.00％(6/60),25.00％(15/60),8.33％(5/60)and 11.67％(7/60),respectively),and the differences were statistically significant(x2=86.14,74.56,8.44 and 19.48,respectively,all P＜0.05).The proportion of interstitial lung disease in non-CPA group was 28.33％(17/60),which was higher than that in CPA group(2.65％,4/151),and the difference was statistically significant(x2=31.61,P＜0.001).The common imaging findings of CPA patients were pulmonary cavity(70.86％,107/151),cavity inclusions(41.72％,63/151)and lung damage(33.77％,51/151).The specificity and sensitivity of serum Aspergillus fumigatus IgG for CPA diagnosis were 81.7％and 68.9％,respectively,and the area under the curve(AUC)was 0.753(95％confidence interval(95％CI)0.681 to 0.825,P＜0.001).The specificity and sensitivity of BALF-GM test were 76.7％and 67.5％,respectively,and the AUC was 0.724(95％CI 0.649 to 0.800,P＜0.001).The specificity and sensitivity of the two methods in series combined detection were 95.0％and 44.4％,respectively,and those of the two methods in parallel detection were 60.3％and 94.5％,respectively.The AUC of the combined diagnosis of CPA by the two methods was 0.843(95％CI 0.783 to 0.903,P＜0.001).Conclusions Serum Aspergillus fumigatus IgG combined with BALF-GM test has a good diagnostic efficacy for CPA.The detection of serum Aspergillus fumigatus IgG is non-invasive and highly specific,which is beneficial to the early diagnosis and treatment of CPA.
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