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  • Title: [Diagnostic value of the combinations of bronchoalveolar lavage fluid pathogen detection and cryptococcal antigen test in pulmonary cryptococcosis].
    Author: Yan QF, Sun ZL, Gao Y, Xiao T, Lin H, Ji M.
    Journal: Zhonghua Jie He He Hu Xi Za Zhi; 2021 Aug 12; 44(8):711-716. PubMed ID: 34645137.
    Abstract:
    Objective: To evaluate the diagnostic value of bronchoalveolar lavage fluid pathogen detection combined with cryptococcal antigen test(CrAg) for pulmonary cryptococcosis(PC). Methods: A retrospective case analysis was performed on non-acquired immunodeficiency syndrome patients admitted to Ninghai First Hospital for suspected PC from January 2018 to December 2019. Fifty-nine patients were included. Sixteen cases (8 males and 8 females) were diagnosed with PC, aged from 18 to 76 years[an average age of (52±14) years], while 43 cases were diagnosed as having Non-PC. All patients had undergone both serum CrAg test and BALF pathogen detection(cultures and direct examination) combined with BALF-CrAg test. The sensitivity and specificity of the combined method of BALF was evaluated, and a parallel comparison of the diagnostic efficiencies of the two methods were made. Results: Of the 16 confirmed PC cases, serum CrAg tests were positive in 11 and negative in 5 cases, while the combined method showed that 14 were positive and 2 were negative. Compared with the clinical final diagnosis, the sensitivity, specificity, positive predictive value and negative predictive value showed that the serum CrAg tests were 68.8% (11/16), 97.7% (42/43), 91.7% (11/12), 89.3% (42/47) respectively, versus 87.5% (14/16), 100.0% (43/43), 100% (14/14), 95.6% (43/45) by the combined method of BALF. The results displayed no statistical difference between the two diagnostic methods (P =1.000). Among the 5 initially serum CrAg-negative cases, 4 were later confirmed as proven PC via the combined method of BALF and the other one by percutaneous lung biopsy. Conclusion: The combined method of BALF pathogen detection with BALF-CrAg showed a similar statistical efficiency rate for diagnosing pulmonary cryptococcosis compared with serum CrAg tests. It may serve as an efficient diagnosis method for PC cases with negative serum CrAg tests. 目的： 探讨BALF隐球菌涂片、培养联合BALF隐球菌抗原（CrAg）检测对肺隐球菌病的诊断价值。 方法： 采用回顾性分析，纳入2018年1月至2019年12月宁海县第一医院收治的疑诊为肺隐球菌病的非获得性免疫缺陷综合征患者59例，其中16例最终诊断为肺隐球菌病，男8例，女8例，年龄18~76（52±14）岁，最终诊断为其他疾病43例。所有患者均进行血清CrAg检测，及BALF联合方法（BALF隐球菌涂片、培养及BALF-CrAg）检测。评价BALF联合方法的敏感度和特异度，并同血清CrAg检测进行比较。 结果： 16例肺隐球菌病中，血清CrAg阳性11例，阴性5例；BALF检出隐球菌14例，2例阴性；BALF-CrAg阳性10例，弱阳性2例，阴性4例；BALF联合方法14例阳性，2例阴性。诊断其他疾病的患者中仅1例血清CrAg弱阳性，余检测均为阴性。对于诊断肺隐球菌病，血清CrAg敏感度为68.8%（11/16），特异度97.7%（42/43），阳性预测值91.7%（11/12），阴性预测值89.3%（42/47）；BALF联合方法敏感度87.5%（14/16），特异度100.0%（43/43），阳性预测值100.0%（14/14），阴性预测值95.6%（43/45）。血清CrAg检测与BALF联合方法的敏感度差异无统计学意义（P=1.000）。5例血清CrAg阴性的确诊患者，4例通过BALF联合方法确诊，1例经肺穿刺活检确诊。 结论： 对肺隐球菌病的诊断，BALF联合方法的诊断价值不亚于血清CrAg，二者可以互补。对血清CrAg阴性的患者，BALF联合方法更具有诊断意义。.
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