Abstract：
BACKGROUND: A clear cutoff value of galactomannan (GM) has not been established for chronic pulmonary aspergillosis (CPA) and is frequently extrapolated from invasive pulmonary aspergillosis. We performed a systematic review and meta-analysis to evaluate the diagnostic performance of serum and bronchoalveolar lavage (BAL) GM, and to propose a cutoff.
METHODS: We extracted from the studies the cutoff of serum or/and BAL GM associated with true positives, false positives, true negatives, and false negatives. We performed a multi-cutoff model and a non-parametric random effect model. We estimated the optimal cutoff and the area under the curve (AUC) for GM in serum and BAL samples.
RESULTS: Nine studies from 1999 to 2021 were included. Overall, the optimal cutoff of serum GM was 0.96 with a sensitivity of 0.29 (95%CI: 0.14-0.51); specificity of 0.88 (95%CI: 0.73-0.95); and AUC of 0.529 (with a CI: [0.415-0.682] [0.307-0.713]). The AUC for the non-parametric ROC model was 0.631. For BAL GM the cutoff was 0.67 with a sensitivity of 0.68 (95%CI: 0.51-0.82), specificity of 0.84 (95%CI: 0.70-0.92), and AUC of 0.814 (with a CI: [0.696-0.895] [0.733-0.881]). The AUC for the non-parametric model was 0.789.
CONCLUSIONS: The diagnosis of CPA requires the assessment of a combination of mycological and serological factors, as no single serum and/or BAL GM antigen test is adequate. BAL GM performed better than serum, with better sensitivity and excellent accuracy.
METHODS: We extracted from the studies the cutoff of serum or/and BAL GM associated with true positives, false positives, true negatives, and false negatives. We performed a multi-cutoff model and a non-parametric random effect model. We estimated the optimal cutoff and the area under the curve (AUC) for GM in serum and BAL samples.
RESULTS: Nine studies from 1999 to 2021 were included. Overall, the optimal cutoff of serum GM was 0.96 with a sensitivity of 0.29 (95%CI: 0.14-0.51); specificity of 0.88 (95%CI: 0.73-0.95); and AUC of 0.529 (with a CI: [0.415-0.682] [0.307-0.713]). The AUC for the non-parametric ROC model was 0.631. For BAL GM the cutoff was 0.67 with a sensitivity of 0.68 (95%CI: 0.51-0.82), specificity of 0.84 (95%CI: 0.70-0.92), and AUC of 0.814 (with a CI: [0.696-0.895] [0.733-0.881]). The AUC for the non-parametric model was 0.789.
CONCLUSIONS: The diagnosis of CPA requires the assessment of a combination of mycological and serological factors, as no single serum and/or BAL GM antigen test is adequate. BAL GM performed better than serum, with better sensitivity and excellent accuracy.
摘要：
背景：尚未确定慢性肺曲霉病（CPA）的半乳甘露聚糖（GM）的明确临界值，并且经常从侵袭性肺曲霉病推断。我们进行了系统评价和荟萃分析，以评估血清和支气管肺泡灌洗（BAL）GM的诊断性能，并提出一个截止日期。
方法：我们从研究中提取了与真阳性相关的血清或/和BALGM的截止值，假阳性,真正的底片，和假阴性。我们进行了多截止模型和非参数随机效应模型。我们估计了血清和BAL样品中GM的最佳截止值和曲线下面积（AUC）。
结果：纳入了1999年至2021年的9项研究。总的来说,血清GM的最佳截断值为0.96,敏感性为0.29(95CI:0.14~0.51);特异性为0.88(95CI:0.73~0.95);AUC为0.529(aCI:[0.415~0.682][0.307~0.713]).非参数ROC模型的AUC为0.631。对于BALGM，截止值为0.67，灵敏度为0.68（95CI：0.51-0.82），特异性为0.84（95CI：0.70-0.92），AUC为0.814（aCI：[0.696-0.895][0.733-0.881]）。非参数模型的AUC为0.789。
结论：诊断CPA需要结合真菌学和血清学因素进行评估，因为没有单一的血清和/或BALGM抗原测试是足够的。BALGM表现优于血清，具有更好的灵敏度和出色的准确性。
方法：我们从研究中提取了与真阳性相关的血清或/和BALGM的截止值，假阳性,真正的底片，和假阴性。我们进行了多截止模型和非参数随机效应模型。我们估计了血清和BAL样品中GM的最佳截止值和曲线下面积（AUC）。
结果：纳入了1999年至2021年的9项研究。总的来说,血清GM的最佳截断值为0.96,敏感性为0.29(95CI:0.14~0.51);特异性为0.88(95CI:0.73~0.95);AUC为0.529(aCI:[0.415~0.682][0.307~0.713]).非参数ROC模型的AUC为0.631。对于BALGM，截止值为0.67，灵敏度为0.68（95CI：0.51-0.82），特异性为0.84（95CI：0.70-0.92），AUC为0.814（aCI：[0.696-0.895][0.733-0.881]）。非参数模型的AUC为0.789。
结论：诊断CPA需要结合真菌学和血清学因素进行评估，因为没有单一的血清和/或BALGM抗原测试是足够的。BALGM表现优于血清，具有更好的灵敏度和出色的准确性。
