[在严重的侵入性支气管肺性阿斯伯吉洛症中进行支气管镜快速现场评估的诊断产量]
Sicheng Xu1, Qiufeng Wan, Jingwen Li
1Department of Respiratory Intensive Care Unit, Pulmonary and Critical Care Medical Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China. Corresponding author: Xu Sicheng,
Zhonghua wei zhong bing ji jiu yi xue
|November 21, 2023
概括
支气管镜快速现场评估 (B-ROSE) 有助于对侵袭性肺阿斯伯吉洛症 (IBPA) 的早期抗真菌治疗决策. 这种快速,准确的方法支持及时干预,但对于某些患者的诊断不足,需要保持警.
科学领域:
- 肺病学和传染病的研究
- 诊断微生物学 诊断微生物学
- 关键护理医学 关键护理医学
背景情况:
- 侵袭性肺阿斯伯吉洛症 (IBPA) 是一种严重的真菌感染,通常需要及时治疗.
- 早期开始抗真菌治疗对于改善IBPA患者的治疗结果至关重要.
- 诊断延迟可能导致发病率和死亡率增加.
研究的目的:
- 为了评估严重IBPA的支气管镜快速现场评估 (B-ROSE) 的诊断产量.
- 评估B-ROSE在最终微生物学结果之前指导早期抗真菌治疗决策的实用性.
- 为了确定B-ROSE在诊断IBPA时的准确性,敏感性和特异性.
主要方法:
- 在呼吸器重症监护病房中,对176名疑似IBPA的严重肺炎患者进行前性队列研究.
- 在入院后24小时内进行B-ROSE;根据国际标准确认诊断.
- 分析包括诊断一致率,ROC曲线,灵敏度,特异性和预测值.
主要成果:
- B-ROSE显示了84.09%的诊断一致率,具有高灵敏度 (87.65%) 和特异性 (81.05%).
- 在ROC曲线下的面积为0.844,表明IBPA的良好预测值.
- 低诊断发生在12.35%,误诊发生在18.95%,特别是在长期使用葡萄糖皮质醇或糖尿病的患者中.
结论:
- B-ROSE是一种快速,简单和可靠的工具,可帮助在严重IBPA的早期抗阿斯伯吉卢斯治疗决策中.
- 在B-ROSE缺乏特征性发现时,具有特定风险因素 (葡萄糖皮质类药物使用,糖尿病) 的患者中,低诊断风险更高.
- 临床医生应保持警,避免误诊其他疾病 (例如肺结核,肺腺癌) 作为IBPA.
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