Clinical data of patients with invasive pulmonary aspergillosis and non-invasive pulmonary aspergillosis.

Objective: To evaluate the diagnostic value of metagenomic next-generation sequencing (mNGS) and galactomannan (GM) test in invasive pulmonary aspergillosis (IPA) and to compare mNGS with other diagnostic approaches, including serum/ bronchoalveolar lavage fluid (BALF)-GM and conventional microbiological tests (CMTs) covering sputum smear and culture, BALF fungal culture and bronchial brushings. Materials and Methods: Totally, 271 patients were finally enrolled in this retrospective study including 154 patients with IPA (120 with mNGS testing) and 117 patients with non-IPA pulmonary infections (all with mNGS testing) treated at Henan Provincial People's Hospital from June 2021 to February 2024. The diagnostic performance of mNGS was compared with conventional diagnostic methods such as serum GM, BALF-GM, sputum smear microscopy, sputum culture, bronchial brushings, and BALF culture. Results: The proportion of patients with underlying diseases in the IPA group was significantly higher than that in the non-IPA group (P<0.05). Compared with conventional diagnostic methods for IPA, mNGS was demonstrated higher diagnostic efficacy, with a sensitivity of 92.5% and a specificity of 94.0%. The area under the receiver operating characteristic (ROC) curve for BALF-GM in diagnosing IPA was 0.8, with an optimal cutoff value of 0.5, sensitivity of 68.2%, and specificity of 82.1%. The combination of mNGS and BALF-GM testing further improved diagnostic performance, yielding a sensitivity of 96.7% and a specificity of 78.6%. Conclusion: The mNGS testing exhibits excellent diagnostic efficacy for IPA, and the combination with BALF-GM testing further enhances sensitivity. This approach has significant potential for early diagnosis and targeted treatment of IPA.

研究目的：评估宏基因组二代测序（metagenomic next-generation sequencing, mNGS）与半乳甘露聚糖（galactomannan, GM）试验对侵袭性肺曲霉病（invasive pulmonary aspergillosis, IPA）的诊断价值，并对比mNGS与其他诊断方法，包括血清/支气管肺泡灌洗液（bronchoalveolar lavage fluid, BALF）-GM试验以及涵盖痰涂片、痰培养、BALF真菌培养及支气管刷检的传统微生物学检测（conventional microbiological tests, CMTs）。
材料与方法：本回顾性研究最终纳入2021年6月至2024年2月于河南省人民医院收治的271例患者，其中IPA患者154例（120例行mNGS检测），非IPA肺部感染患者117例（均行mNGS检测）。将mNGS的诊断性能与血清GM、BALF-GM、痰涂片镜检、痰培养、支气管刷检及BALF培养等传统诊断方法进行对比。
结果：IPA组患者基础疾病患病率显著高于非IPA组（P<0.05）。相较于IPA的传统诊断方法，mNGS展现出更优的诊断效能，灵敏度为92.5%，特异度为94.0%。用于诊断IPA的BALF-GM受试者工作特征（receiver operating characteristic, ROC）曲线下面积为0.8，最佳截断值为0.5，灵敏度为68.2%，特异度为82.1%。联合mNGS与BALF-GM检测可进一步提升诊断性能，灵敏度达96.7%，特异度为78.6%。
结论：mNGS检测对IPA具有优异的诊断效能，联合BALF-GM检测可进一步提升灵敏度，该方案在IPA的早期诊断与靶向治疗中具有重要应用潜力。