【摘要】 目的 评估肺泡灌洗液半乳甘露聚糖（GM）试验联合宏基因组下一代测序（mNGS）对肺曲霉菌感染的诊断价值，为临床早期准确诊断提供参考。方法 选取2023-01-01-2024-12-31建湖县人民医院90例经CT提示可能肺曲霉菌感染的患者为研究对象，均采集肺泡灌洗液进行GM试验和mNGS检测，以组织病理学检查结果为金标准，分析2种方法单独及联合应用的诊断效能（灵敏度、特异度、准确率），绘制受试者工作特征（ROC）曲线评估诊断效能。结果 90例患者中，经组织病理学确诊肺曲霉菌感染51例，非真菌感染39例。单纯GM试验诊断的灵敏度为88.24%(45/51)、特异度为92.31%(36/39)、准确率为90.00%(81/90)，曲线下面积（AUC）为0.903；单纯mNGS检测的灵敏度为94.12%(48/51)、特异度为87.18%(34/39)、准确率为91.11%(82/90),AUC为0.884；联合检测的灵敏度为98.04%、特异度为94.87%、准确率为96.67%,AUC为0.965，均高于单一检测方法（P<0.05），且与金标准的一致性良好（Kappa=0.932）。结论 肺泡灌洗液GM试验联合mNGS检测可提升肺曲霉菌感染的诊断效能，与组织病理学检查一致性高。更多还原

【Abstract】 Objective To evaluate the diagnostic value of bronchoalveolar lavage fluid(BALF)galactomannan(GM)test combined with metagenomic next-generation sequencing(mNGS)for pulmonary aspergillosis,so as to provide a reference for early and accurate clinical diagnosis.Methods A total of 90 patients with suspected pulmonary aspergillosis indicated by CT in Jianhu County People’s Hospital from January 1,2023 to December 31,2024 were selected as research subjects.BALF was collected from all patients for GM test and mNGS detection.With the results of histopathological examination as the gold standard,the diagnostic efficacy(sensitivity,specificity,accuracy)of the two methods alone and in combination was analyzed,and the receiver operating characteristic(ROC)curve was plotted to evaluate the diagnostic efficacy.Results Among the 90 patients,51 cases were confirmed to have pulmonary aspergillosis by histopathology,and 39 cases were non-fungal infections.For the GM test alone,the sensitivity,specificity and accuracy were 88.24%(45/51),92.31%(36/39)and 90.00%(81/90)respectively,with an area under the curve(AUC)of 0.903.For mNGS alone,the sensitivity,specificity and accuracy were 94.12%(48/51),87.18%(34/39)and 91.11%(82/90)respectively,with an AUC of 0.884.For the combined detection,the sensitivity,specificity and accuracy were 98.04%,94.87% and96.67%respectively,with an AUC of 0.965,which were all higher than those of the single detection method(P<0.05),and showed good consistency with the gold standard(Kappa=0.932).Conclusion The combination of BALF GM test and mNGS can significantly improve the diagnostic efficacy of pulmonary aspergillosis,with high consistency with histopathological examination.更多还原