程丹 1杨宏山 1彭敏华 2万小丹 3万璐 2贾晓艳2
作者信息
- 1. 孝感市中心医院肿瘤Ⅱ科,湖北 孝感 432000
- 2. 孝感市中心医院肿瘤科,湖北 孝感 432000
- 3. 监利市人民医院妇产科,湖北监利 433300
- 折叠
摘要
Abstract
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.关键词
非小细胞肺癌/化疗/肺部真菌感染/GM 试验/G 试验/TNF-αKey words
non-small cell lung cancer/chemotherapy/pulmonary fungal infection/GM test/G test/TNF-α
