Table 1_Non-invasive monitoring of Aspergillus infections in chronic lung disease patients: a combined serology and HRCT imaging approach.xlsx

BackgroundDiagnosing Aspergillus infections in patients with chronic pulmonary diseases is challenging, particularly in settings where invasive diagnostic tools are limited. This study explores a non-invasive diagnostic approach, combining serological tests and high-resolution computed tomography (HRCT) imaging, to identify patients who may need further invasive evaluation for Aspergillus infection.
MethodsThis retrospective study included patients with chronic pulmonary diseases from regional centers who experienced acute exacerbations that did not respond to antibacterial therapy, had positive sputum cultures for Aspergillus species, and lacked typical invasive radiological features on HRCT. Patients were classified based on clinical data, HRCT imaging, and serological markers (IgG, IgM, galactomannan) to distinguish between Aspergillus colonization and clinically diagnosed active infection.
ResultsOf the 2,731 patients assessed, 209 met the study criteria: 112 were identified with Aspergillus colonization, and 97 with clinically diagnosed Aspergillus infection. Patients with active infection had significantly higher Aspergillus -specific IgG levels (median 185.47 IU/mL vs. 59.96 IU/mL, p<0.001) and higher galactomannan indices, especially those with invasive infection (p<0.001). HRCT scores were strongly correlated with the risk of infection. The combination of IgG levels and HRCT scores achieved an AUC (area under the curve) of 0.9 for differentiating infection from colonization and 0.74 for distinguishing different types of Aspergillus infections.
ConclusionThis study supports the use of a non-invasive diagnostic approach, combining serological testing and HRCT imaging, to identify patients with chronic lung diseases who have positive sputum cultures for Aspergillus and are highly suspected of active infection, such as invasive pulmonary aspergillosis and chronic pulmonary aspergillosis, for further invasive diagnostic evaluation. This method is particularly useful in patients who experience frequent acute exacerbations and are unwilling or unable to undergo invasive diagnostic procedures, helping clinicians identify those who really require further definitive evaluation and thereby reducing unnecessary antifungal treatment.
Clinical trial registrationhttps://www.clinicaltrials.gov, identifier NCT06379568.

背景 慢性肺部疾病患者的曲霉（Aspergillus）感染诊断颇具挑战，尤其是在侵入性诊断工具资源受限的医疗场景中。本研究探索了一种结合血清学检测与高分辨率计算机断层扫描（HRCT）的非侵入性诊断方法，用于甄别需进一步接受曲霉感染侵入性评估的患者。
方法 本项回顾性研究纳入了来自区域医疗中心的慢性肺部疾病患者，这些患者出现了对抗菌治疗无应答的急性加重、痰培养曲霉属检测呈阳性，且HRCT未显示典型侵入性放射学特征。研究人员基于临床数据、HRCT影像及血清学标志物（IgG、IgM、半乳甘露聚糖（galactomannan））对患者进行分类，以区分曲霉定植与临床确诊的活动性感染。
结果 共纳入2731例接受评估的患者，其中209例符合研究标准：112例被诊断为曲霉定植，97例临床确诊为曲霉感染。活动性感染患者的曲霉特异性IgG水平显著更高（中位数185.47 IU/mL vs. 59.96 IU/mL，p<0.001），半乳甘露聚糖指数也更高，尤其是侵入性感染患者（p<0.001）。HRCT评分与感染风险呈强相关性。联合应用IgG水平与HRCT评分，在区分感染与定植时的曲线下面积（AUC，area under the curve）为0.9，在区分不同类型曲霉感染时的AUC为0.74。
结论 本研究证实，结合血清学检测与HRCT成像的非侵入性诊断方法，可用于甄别慢性肺部疾病中痰培养曲霉阳性、高度疑似活动性感染（如侵入性肺曲霉病与慢性肺曲霉病）的患者，以开展进一步的侵入性诊断评估。该方法尤其适用于频繁出现急性加重、不愿或无法接受侵入性诊断操作的患者，可帮助临床医师识别真正需要进一步明确评估的患者，从而减少不必要的抗真菌治疗。
临床试验注册 https://www.clinicaltrials.gov，注册号NCT06379568。