宏基因组二代测序和半乳甘露聚糖检测对侵袭性肺曲霉菌病的诊断价值  

Diagnostic value of metagenomic next-generation sequencing and galactomannan test in invasive pulmonary aspergillosis

作　　者：杨佳 张茜茜 林晨晨 武旋 于奕 张鑫妍 安云霞 YANG Jia;ZHANG Qianqian;LIN Chenchen;WU Xuan;YU Yi;ZHANG Xinyan;AN Yunxia(Department of Respiratory and Critical Care Medicine,Henan Provincial People's Hospital.Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]河南省人民医院呼吸与危重症医学科郑州大学人民医院,河南郑州1450003

出　　处：《中华实用诊断与治疗杂志》2025年第3期277-282,共6页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：目的 探讨支气管肺泡灌洗液(BALF)宏基因组二代测序(mNGS)、BALF半乳甘露聚糖(GM)试验、血清GM试验诊断侵袭性肺曲霉菌病(IPA)的价值。方法 2021年6月—2024年2月河南省人民医院诊治235例肺部感染患者,均行传统微生物学检测(CMT)(包括痰涂片、痰培养、气管镜刷检和BALF培养)、血清GM试验、BALF GM试验和BALF mNGS检测。临床诊断IPA患者118例为IPA组,非IPA的肺部感染患者117例为非IPA组,比较2组血清GM、BALF GM值;以临床诊断结果为金标准,计算血清GM、BALF GM、BALF mNGS诊断IPA的灵敏度、特异度、阳性预测值、阴性预测值;根据血清GM和BALF GM诊断IPA的约登指数确定其最佳截断值,绘制ROC曲线,评估血清GM、BALF GM以及BALF mNGS诊断IPA的效能。结果 (1)IPA组118例中血清GM阳性22例,GM值为0.252(0.129,0.756);BALF GM阳性58例,GM值为0.894(0.382,2.994)。非IPA组117例中血清GM阳性3例,GM值为0.182(0.134,0.236);BALF GM阳性7例,GM值为0.270(0.176,0.412)。IPA组血清GM、BALF GM值均高于非IPA组(U=-7.83,P<0.001;U=-2.90,P=0.004)。(2)IPA组118例中BALF mNGS检出曲霉菌109例,其中烟曲霉菌60例、黄曲霉菌35例、黑曲霉菌11例、土曲霉菌3例、构巢曲霉菌1例、百岁兰曲霉菌2例,19例患者为多种曲霉菌混合感染。(3)以临床诊断结果为金标准,血清GM、BALF GM诊断IPA的灵敏度分别为18.6%、49.2%,特异度分别为97.4%、94.0%,阳性预测值分别为88.0%、89.2%,阴性预测值分别为54.3%、64.7%,约登指数分别为0.16、0.43。BALF mNGS诊断IPA的灵敏度、特异度、阳性预测值和阴性预测值分别为92.4%、94.0%、93.9%和92.4%。(4)ROC曲线分析结果显示,血清GM、BALF GM分别以0.295、0.546为最佳截断值,BALF mNGS以阳性为节点,诊断IPA的AUC分别为0.61(95%CI:0.53~0.69,P=0.002)、0.80(95%CI:0.74~0.85,P<0.001)、0.94(95%CI:0.91~0.97,P<0.001)。结论 与非IPA的肺部感染患者比较,IPA患者血清GM、BALF GM值增高;BALF GM诊断IPA的效�Objective To explore the diagnostic value of bronchoalveolar lavage fluid(BALF)metagenomic next-generation sequencing(mNGS),BALF galactomannan(GM)test,and serum GM test for invasive pulmonary aspergillosis(IPA).Methods Totally 235 patients with pulmonary infections were treated in Henan Provincial People's Hospital from June 2021 to February 2024.All patients underwent conventional microbiological tests(CMT)(sputum smear,sputum culture,bronchoscopic brush biopsy,BALF culture),serum GM test,BALF GM test,and BALF mNGS test.Among them,118 patients were clinically diagnosed with IPA(the IPA group),and 117 had non-IPA pulmonary infections(the non-IPA group).The values of serum GM and BALF GM were compared between two groups.Using clinical diagnosis as the gold standard,the sensitivities,specificities,positive predictive values,and negative predictive values of serum GM,BALF GM,and BALF mNGS for diagnosing IPA were calculated.The optimum cut-off values of serum GM and BALF GM were determined based on their Youden indexes for the diagnosis of IPA.ROC curves were plotted to evaluate the efficiencies of serum GM,BALF GM,and BALF mNGS on diagnosing IPA.Results(1)Among the 118 patients in the IPA group,serum GM was positive in 22 cases,with a GM value of 0.252(0.129,0.756),and BALF GM was positive in 58 cases,with a GM value of 0.894(0.382,2.994).Among the 117 patients in the non-IPA group,serum GM was positive in 3 cases,with a GM value of 0.182(0.134,0.236),and BALF GM was positive in 7 cases,with a GM value of 0.270(0.176,0.412).Serum GM and BALF GM values were higher in the IPA group than those in the non-IPA group(U=-7.83,P<0.001;U=-2.90,P=0.004).(2)Among 118 patients in the IPA group,109 cases of Aspergillus were detected with BALF mNGS,including 60 cases of Aspergillus fumigatus,35 of Aspergillus flavus,11 of Aspergillus niger,3 of Aspergillus terreus,1 of Aspergillus nidulans,and 2 of Aspergillus welwitschiae.Nineteen patients were infected with multiple Aspergillus.(3)Using clinical diagnosis results as the gold st

关 键 词：侵袭性肺曲霉菌病 支气管肺泡灌洗液 宏基因组二代测序 半乳甘露聚糖检测 

分 类 号：R519[医药卫生—内科学]