Diagnostic value of bronchoalveolar lavage fluid mGNS technology combined with inflammatory factors for chronic obstructive pulmonary disease complicated with fungal infection
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摘要:
目的 为提高慢性阻塞性肺疾病(COPD)合并真菌感染诊断方法的准确性，针对当前传统诊断方法灵敏度和特异度均不理想的问题，本研究主要探究支气管肺泡灌洗液宏基因组二代测序(mGNS)技术联合炎症因子对该病的诊断价值，旨在为临床诊断提供可靠依据。 方法 选取2022年6月—2024年6月新疆维吾尔自治区人民医院收治的102例COPD合并真菌感染患者作为真菌组、102例COPD未合并感染患者作为无感染组。比较2组临床资料、炎症因子[肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介素-2(IL-2)]水平，采用Pearson相关性分析研究炎症因子与肺功能[第1秒用力呼气量(FEV1)、用力肺活量(FVC)、FEV1/FVC]的相关性，采用ROC曲线分析mGNS、炎症因子对COPD合并真菌感染的诊断价值。 结果 真菌组糖尿病、低蛋白血症比例、血清TNF-α、IL-6、IL-2水平高于无感染组，FEV1、FVC、FEV1/FVC低于无感染组(P＜0.05)；血清TNF-α、IL-6、IL-2水平与肺功能均呈负相关关系(P＜0.05)；血清TNF-α、IL-6、IL-2诊断COPD合并真菌感染的AUC为0.793、0.754、0.778；mGNS诊断COPD合并真菌感染的灵敏度为91.18%，特异度为86.27%；mGNS联合血清TNF-α、IL-6、IL-2诊断COPD合并真菌感染的AUC为0.960，联合预测价值最大(P＜0.05)。 结论 mGNS联合血清TNF-α、IL-6、IL-2在诊断COPD合并真菌感染中具有较高的临床价值。 -
关键词:
- 慢性阻塞性肺疾病 /
- 支气管肺泡灌洗液 /
- 宏基因组二代测序技术 /
- 炎症因子 /
- 真菌感染
Abstract:Objective To improve the accuracy of diagnostic methods for chronic obstructive pulmonary disease (COPD) complicated with fungal infections. In response to the unsatisfactory sensitivity and specificity of traditional diagnostic methods, the main focus of this study is to explore the diagnostic value of bronchoalveolar lavage fluid mGNS technology combined with inflammatory factors for this disease, aiming to provide a reliable basis for clinical diagnosis. Methods A total of 102 patients with COPD complicated with fungal infection admitted to the People ' s Hospital of Xinjiang Uygur Autonomous Region from June 2022 to June 2024 were selected as the fungal infection group, and 102 patients with COPD without infection were selected as the non-infection group. The clinical data and levels of inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-2 (IL-2)] were compared between the two groups. Pearson analysis was used to investigate the correlation between inflammatory factors and lung function [forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC]. Receiver operating characteristic (ROC) curves were used to analyze the diagnostic value of mGNS and inflammatory factors for COPD complicated with fungal infections. Results The proportion of diabetes and hypoproteinemia, serum TNF-α, IL-6, and IL-2 levels in the fungal infection group were higher than those in the non-infection group, while FEV1, FVC, and FEV1/FVC were lower than those in the non-infection group (P < 0.05). The levels of serum TNF-α, IL-6, and IL-2 were negatively correlated with lung function (P < 0.05). The AUC of serum TNF-α, IL-6, and IL-2 for diagnosing COPD with fungal infection were 0.793, 0.754, and 0.778, respectively. The sensitivity and specificity of mGNS in diagnosing COPD complicated with fungal infection were 91.18% and 86.27%, respectively. The AUC of mGNS combined with serum TNF-α, IL-6, and IL-2 for the diagnosis of COPD with fungal infection was 0.960, and the combined predictive value was the highest (P < 0.05). Conclusion The combination of mGNS and serum TNF-α, IL-6, and IL-2 has high clinical value in the diagnosis of COPD complicated with fungal infection. -
图 1 炎症因子诊断COPD合并真菌感染的ROC曲线
Figure 1. ROC curve of inflammatory factors in the diagnosis of COPD complicated with fungal infection
图 2 mGNS联合血清TNF-α、IL-6、IL-2诊断COPD合并真菌感染的ROC曲线
Figure 2. ROC curve of mGNS combined with serum TNF-α, IL-6 and IL-2 in the diagnosis of COPD complicated with fungal infection
表 1 COPD合并真菌感染与未合并真菌感染患者临床资料及炎症因子比较
Table 1. Comparison of clinical data and inflammatory factors between COPD patients with fungal infection and those without fungal infection
项目 真菌组(n=102) 无感染组(n=102) 统计量 P值 性别[例(%)] 0.188a 0.665 男性 62(60.78) 65(63.73) 女性 40(39.22) 37(36.27) 年龄(x±s，岁) 65.21±5.29 64.83±5.06 0.524b 0.601 BMI(x±s) 21.58±1.47 21.36±1.35 1.113b 0.267 COPD病程(x±s，年) 5.06±1.25 4.85±1.12 1.264b 0.208 基础疾病[例(%)] 糖尿病 38(37.25) 16(15.69) 12.190a ＜0.001 低蛋白血症 41(40.20) 17(16.67) 13.876a ＜0.001 高血压 33(32.35) 29(28.43) 0.371a 0.543 肺功能指标(x±s) FEV1(L) 1.04±0.21 1.36±0.30 8.825b ＜0.001 FVC(L) 2.03±0.24 2.32±0.33 7.178b ＜0.001 FEV1/FVC(%) 51.23±5.49 58.62±6.11 9.086b ＜0.001 炎症因子(x±s，pg/mL) TNF-α 44.96±9.38 35.20±7.42 8.242b ＜0.001 IL-6 9.58±1.41 8.32±1.18 6.921b ＜0.001 IL-2 252.77±32.15 225.06±24.63 6.910b ＜0.001 注：a为χ2值，b为t值。 
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表 2 TNF-α、IL-6、IL-2与FEV1、FVC、FEV1/FVC的相关性
Table 2. Correlation between TNF-α, IL-6, IL-2 and FEV1, FVC, FEV1/FVC
项目 FEV1 FVC FEV1/FVC r值 P值 r值 P值 r值 P值 TNF-α -0.682 ＜0.001 -0.703 ＜0.001 -0.714 ＜0.001 IL-6 -0.664 ＜0.001 -0.675 ＜0.001 -0.701 ＜0.001 IL-2 -0.637 ＜0.001 -0.652 ＜0.001 -0.685 ＜0.001
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表 3 mGNS和传统病原菌培养的诊断结果
Table 3. Diagnostic results of mGNS and traditional pathogen culture
方法 类别 临床诊断(例) 灵敏度(%) 特异度(%) + - mGNS + 93 10 91.18 86.27 - 9 92 传统病原菌 + 77 20 75.49 80.39 - 25 82
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