Diagnostic value of bronchoalveolar lavage fluid Aspergillus-specific fluorescence PCR assay combined with galactomannan assay in non-neutropenia IPA patients
Objective To evaluate the value of bronchoalveolar lavage fluid Aspergillus-specific fluorescent PCR assay combined with galactomannan(GM)assay in the diagnosis of patients with non-neutropenic invasive pulmonary aspergillosis(IPA).Methods From March 2022 to December 2023,113 hospitalized patients with clinically suspected IPA were selected from the Zibo First Hospital of Zibo City,Shandong Province.Bronchoalveolar lavage fluid samples from each patient were simultaneously subjected to potassium hydroxide microscopy,fungal culture,GM assay,and Aspergillus-specific fluorescence PCR assay.According to the diagnostic criteria of IPA,patients were divided into clinically diagnosed IPA and non-IPA groups.The values of these four methods for the diagnosis of IPA were compared.Results According to the diagnostic criteria for IPA,37 out of the 113 suspected patients were clinically diagnosed as IPA.The proportion of diabetic patients was significantly higher in the IPA group compared to the non-IPA group(χ2=7.494,P=0.006);similarly,the proportion of patients using glucocorticoids was significantly higher in the IPA group(χ2=6.981,P=0.008).Patients in the IPA group more frequently showed cavitation within consolidation areas on imaging,which was statistically significant(χ2=15.603,P<0.001).There were significant differences in the sensitivity of the four fungal detection methods in the diagnosis of IPA(χ2=45.803,P<0.001),with Aspergillus-specific PCR assay showing the highest sensitivity at 94.59%.Specificity also varied significantly across the four methods(χ2=31.511,P<0.001),with the highest specificity being seen in potassium hydroxide microscopy and fungal culture at 100.00%.There were significant differences in the clinical coincidence rate of the four methods in the diagnosis of IPA(χ2=11.768,P=0.008),with Aspergillus-specific fluorescence PCR assay having the highest coincidence rate at 90.27%.The AUC of the ROC curve of Aspergillus-specific fluorescent PCR assay combined with the GM assay was 0.976 7,higher than 0.913 8 by Aspergillus-specific fluorescent PCR assay merely.Conclusions The combination of Aspergillus-specific fluorescent PCR assay and GM assay using bronchoalveolar lavage fluid could significantly improve the accuracy of IPA diagnosis in patients without neutropenia.
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