nodgoРоссийский журнал детской гематологии и онкологии (РЖДГиО)Russian Journal of Pediatric Hematology and Oncology2311-12672413-5496LTD “Graphica”10.17650/2311-1267-2015-2-2-72-76nodgo-104Research ArticleПРОБЛЕМЫ ПРАКТИЧЕСКОЙ ГЕМАТОЛОГИИ-ОНКОЛОГИИPROBLEMS OF PRACTICAL HEMATOLOGY/ONCOLOGYРОЛЬ БРОНХОСКОПИИ В ДИАГНОСТИКЕ ИНВАЗИВНОГО АСПЕРГИЛЛЕЗА ЛЕГКИХ У ДЕТЕЙ ПОСЛЕ ТРАНСПЛАНТАЦИИ ГЕМОПОЭТИЧЕСКИХ СТВОЛОВЫХ КЛЕТОКTHE ROLE OF BRONCHOSCOPY IN DIAGNOSIS INVASIVE PULMONARY ASPERGILLOSIS IN CHILDREN AFTER HEMATOPOIETIC STEM CELL TRANSPLANTATIONВолковаА. Г.VolkovaA. G.alisa-md@inbox.ruПоповаМ. О.PopovaM. O.ЕкушевК. А.EkushevK. A.ЗиннатуллинИ. Р.ZinnatullinI. R.НиколаевИ. Ю.NikolaevI. Yu.БогомоловаТ. С.BogomolovaT. S.ИгнатьеваС. М.IgnatievaS. M.СмирновБ. И.SmirnovB. I.ЗубаровскаяЛ. С.ZubarovskayaL. S.КлимкоН. Н.KlimkoN. N.АфанасьевБ. В.AfanasievB. V.Клиника НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой ГБОУ ВПО Первый СПбГМУ им. акад. И. П. Павлова Минздрава России; Россия, 197022, Санкт-Петербург, ул. Рентгена, 12РоссияClinic of Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St.Petersburg, Ministry of Health of Russia; 12 Rentgena St., Saint Petersburg, 197022, RussiaRussian FederationГБОУ ВПО «Северо-Западный государственный медицинский университет им. И. И. Мечникова» Минздрава России; Россия, 194291, Санкт-Петербург, ул. Сантьяго-де-Куба, 1/28;РоссияI.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia; 1/28 Santiyago-de-Kuba St., Saint Petersburg, 194291, RussiaRussian FederationФГАОУ ВО «Санкт-Петербургский государственный электротехнический университет “ЛЭТИ” им. В. И. Ульянова (Ленина)»; Россия, 197376, Санкт-Петербург, ул. Профессора Попова, 5РоссияSaint-Petersburg Electrotechnical University “LETI” named after V. I. Ulianov (Lenin); 5 Professora Popova St., Saint Petersburg, 197376, RussiaRussian FederationГБОУ ВПО «Северо-Западный государственный медицинский университет им. И. И. Мечникова» Минздрава России; Россия, 194291, Санкт-Петербург, ул. Сантьяго-де-Куба, 1/28;РоссияI.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia; 1/28 Santiyago-de-Kuba St., Saint Petersburg, 194291, Russia;Russian Federation201529052015227276Copyright © Волкова А.Г., Попова М.О., Екушев К.А., Зиннатуллин И.Р., Николаев И.Ю., Богомолова Т.С., Игнатьева С.М., Смирнов Б.И., Зубаровская Л.С., Климко Н.Н., Афанасьев Б.В., 20152015Волкова А.Г., Попова М.О., Екушев К.А., Зиннатуллин И.Р., Николаев И.Ю., Богомолова Т.С., Игнатьева С.М., Смирнов Б.И., Зубаровская Л.С., Климко Н.Н., Афанасьев Б.В.Volkova A.G., Popova M.O., Ekushev K.A., Zinnatullin I.R., Nikolaev I.Y., Bogomolova T.S., Ignatieva S.M., Smirnov B.I., Zubarovskaya L.S., Klimko N.N., Afanasiev B.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nodgo.org/jour/article/view/104

Мы оценили безопасность и эффективность комплексного исследования образцов жидкости бронхоальвеолярного лаважа (БАЛ) (n = 222) для диагностики инвазивного аспергиллеза легких (ИАЛ) у 150 пациентов после трансплантации гемопоэтических стволовых клеток (ТГСК) детского возраста. Значимых побочных явлений при проведении бронхоскопии не было. ИАЛ был выявлен у 30 % реципиентов ТГСК с изменениями в легких на компьютерной томографии. При многофакторном анализе тест на галактоманнан (ГМ) в БАЛ показал более высокие показатели чувствительности по сравнению с прямой микроскопией и посевом (83,3 и 46,3 % соответственно). При индексе оптической плотности, равном 0,925, диагностическая точность, показанная площадью под кривой при ROC-анализе, составила 0,794 (95 % доверительный интервал 0,665–0,923). Наибольшая диагностическая эффективность достигается многофакторным анализом при использовании всех 3 указанных методов – микроскопии, посева и теста на ГМ в БАЛ.

We have evaluated the safety and efficiency of the comprehensive examination of the bronchoalveolar lavage (BAL) (n = 222) for the diagnosis of the invasive aspergillosis of lungs (IAL) at 150 patients after the hematopoietic stem cell transplantation (HSCT) in childhood. There were no major adverse effects during the bronchoscopy. IAL was revealed at 30 % of HSCT recipients with changes in lungs at the computer tomogram. The multivariant analysis the galactomannan (GM) test in IAL showed higher sensitivity indices in comparison with the direct microscopy and inoculation (83.3 and 46.3 % accordingly). With the optic density index equal to 0.925, the diagnostic precision, showed by the area under curve at ROC-аnalaysis, was 0.794 (95 % confidence interval 0.665–0.923). The most diagnostic efficiency is achieved by the multivariant analysis, when using all 3 mentioned methods – microscopy, inoculation and GM test in IAL.

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The authors declare that there are no conflicts of interest present.