血清GM试验、G试验及TNF-α联合检测对非小细胞肺癌化疗期间肺部真菌感染的早期识别价值OA
Early identification value of serum GM test,G test,and TNF-α combined detection for pulmonary fungal infections during chemotherapy in non-small cell lung cancer patients
目的 探讨血清半乳甘露聚糖(galactomannan,GM)试验、(1,3)-β-D 葡聚糖[(1,3)-β-D-glucan,G]试验及肿瘤坏死因子(tumor necrosis factor,TNF-α)联合检测对非小细胞肺癌(non-small cell lung cancer,NSCLC)化疗期间肺部真菌感染的早期识别价值.方法 前瞻性纳入 2022 年 1 月—2025 年 6 月期间在孝感市中心医院接受化疗的 NSCLC 患者 280 例,化疗前及化疗期间每周采集血清,同时记录临床症状、影像学及微生物学结果.采用酶联免疫法检测 GM 试验(临界值≥0.5)、显色法检测 G 试验(临界值≥80 pg/mL)、ELISA 法检测 TNF-α(临界值≥50 pg/mL).参照《侵袭性肺真菌病诊断与治疗指南(2025 年版)》中肺部真菌感染的金标准,分析各指标及联合检测的灵敏度、特异度、阳性预测值、阴性预测值及受试者工作特征曲线.结果 280 例患者中,男性 172 例(61.4％),女性 108 例(38.6％);年龄 45～78 岁,中位年龄 62 岁;腺癌 168 例(60.0％),鳞癌 112 例(40.0％);Ⅲ B 期 120 例(42.9％),Ⅳ期160 例(57.1％),42 例确诊肺部真菌感染(感染率 15.0％);随着抗真菌治疗的进行及化疗周期的延续,患者血清中 GM试验、G 试验及 TNF-α 的阳性率逐渐下降:在确诊后 1～2 周,三项指标联合检测阳性率为 85.7％(36/42);3～4 周降至54.8％(23/42);化疗结束时,联合检测阳性率进一步降至19.0％(8/42).受试者工作特征曲线显示,GM 试验、G 试验、TNF-α 单独检测的灵敏度分别为66.7％、71.4％、69.0％,特异度分别为89.2％、85.7％、87.5％.联合检测(GM+G+TNF-α)的灵敏度(90.5％)和特异度(92.9％)显著高于单一检测(P<0.05),曲线下面积达 0.943(95％CI:0.912～0.974),联合检测的阳性预测值和阴性预测值分别为88.9％和 93.8％.多因素 logistic 回归分析显示,化疗周期数是肺部真菌感染的独立危险因素(OR=3.25).联合检测对曲霉感染及念珠菌感染的曲线下面积分别为 0.964(95％CI:0.932～0.996)和 0.935(95％CI:0.891～0.979)均显示出较高的诊断准确性.结论 血清 GM 试验、G 试验及 TNF-α 联合检测可显著提高非小细胞肺癌化疗期间肺部真菌感染的早期诊断效能,为临床及时干预提供依据.
Objective To investigate the early identification value of serum galactomannan(GM)test,(1,3)-β-D-glucan(G)test,and tumor necrosis factor(TNF-α)combined detection for pulmonary fungal infections during chemotherapy in non-small cell lung cancer(NSCLC)patients.Methods A total of 280 NSCLC patients undergoing chemotherapy from January 2022 to June 2025 in Xiaogan Central Hospital were prospectively enrolled.Serum samples were collected weekly before and during chemotherapy.Clinical symptoms,imaging,and microbiological results were recorded.GM test(cut-off value≥0.5)was detected by ELISA,G test(cut-off value≥80 pg/mL)by chromogenic method,and TNF-α(cut-off value≥50 pg/mL)by ELISA.According to the Guidelines for the Diagnosis and Treatment of Invasive Pulmonary Fungal Infections(2025 Edition),the sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and area under the receiver operating characteristic curve(AUC)were analyzed.Results Among the 280 patients,172 were male(61.4％)and 108 were female(38.6％).The age ranged from 45 to 78 years,with a median age of 62.Adenocarcinoma accounted for 168 cases(60.0％),while squamous cell carcinoma represented 112 cases(40.0％).Of these,120 were in stage Ⅲ-B(42.9％)and 160 in stage Ⅳ(57.1％).Forty-two patients(15.0％)had confirmed pulmonary fungal infections.As antifungal therapy progressed and chemotherapy cycles continued,positive rates of serum GM test,G test,and TNF-α in patientsgradually decreased.The positive rate of combined detection of the three indicators was 85.7％(36/42)during the first 1-2 weeks after diagnosis;it dropped to 54.8％(23/42)by 3-4 weeks;and further decreased to 19.0％(8/42)by the end of chemotherapy.ROC curves demonstrated that the sensitivity of GM test,G test,and TNF-α alone were 66.7％,71.4％,and 69.0％respectively,with specificity at 89.2％,85.7％,and 87.5％.The combined test(GM+G+TNF-α)showed significantly higher sensitivity(90.5％)and specificity(92.9％)compared to single tests(P<0.05),achieving an AUC of 0.943(95％CI:0.912-0.974).The PPV and NPV for the combined test were 88.9％and 93.8％respectively.Multivariate logistic regression analysis showed that the number of chemotherapy cycles was an independent risk factor for pulmonary fungal infections(OR=3.25).The AUC values of combined testing for Aspergillus infection and Candida infection were 0.964(95％CI:0.932-0.996)and 0.935(95％CI:0.891-0.979),respectively,both indicating high diagnostic accuracy.Conclusion Combined detection of serum GM test,G test,and TNF-α significantly improves the early diagnostic efficacy of pulmonary fungal infections during NSCLC chemotherapy,providing a basis for timely clinical intervention.
程丹;杨宏山;彭敏华;万小丹;万璐;贾晓艳
孝感市中心医院肿瘤Ⅱ科,湖北 孝感 432000孝感市中心医院肿瘤Ⅱ科,湖北 孝感 432000孝感市中心医院肿瘤科,湖北 孝感 432000监利市人民医院妇产科,湖北监利 433300孝感市中心医院肿瘤科,湖北 孝感 432000孝感市中心医院肿瘤科,湖北 孝感 432000
非小细胞肺癌化疗肺部真菌感染GM 试验G 试验TNF-α
non-small cell lung cancerchemotherapypulmonary fungal infectionGM testG testTNF-α
《中国真菌学杂志》 2026 (2)
141-146,6
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