Liu Yang, Tang Qiuping, Tang Sishi, Huang Hengjian, Kou Lanxi, Zhou Yi, Ruan Hongxia, Yuan Yu, He Chao, Ying Binwu
Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China.
West China Precision Medicine Industrial Technology Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China.
Clin Chim Acta. 2025 Mar 1;569:120153. doi: 10.1016/j.cca.2025.120153. Epub 2025 Jan 23.
Invasive pulmonary aspergillosis (IPA), the most common fungal infection, is associated with high mortality of affected patients. Traditional diagnostic methods exhibit limited sensitivity and specificity, raising big challenges for precise management of the patients. There is thus an urgent need to find out a timely and accurate diagnostic method in clinical practice. In this study, 163 patients suspected with IPA were enrolled. The medical data of the patients were retrieved from hospital information system. The 158 patients with complete data were classified into an IPA group with 122 cases (58 putative IPA, 19 probable IPA, and 45 possible IPA cases) and a non-IPA group with 36 cases. Cell-free DNA (cfDNA) of bronchoalveolar lavage fluid (BALF) or plasma samples was detected via a droplet digital PCR (ddPCR) assay targeting Aspergillus spp. Overall, this ddPCR assay demonstrated a higher sensitivity of 50.8 % for IPA diagnosis, compared with that of fungal culture (44.3 %) and smear test (10.7 %). Moreover, its sensitivity was higher in the IPA group (73.1 %) and putative IPA subgroup (88.2 %) when using BALF samples, compared with those using plasma samples (P < 0.01). It achieved a high specificity of 94.4 % for IPA diagnosis, with significant variations in cfDNA copy numbers across the subgroups (P < 0.05). In addition, the ddPCR results were associated with the prognosis of the patients at the discharge (P < 0.05). In conclusion, ddPCR assay demonstrated a good performance for IPA diagnosis when using BALF samples, especially for putative IPA. The ddPCR results could be integrated with clinical data to improve prognostic prediction.
侵袭性肺曲霉病（IPA）是最常见的真菌感染，与受影响患者的高死亡率相关。传统诊断方法的敏感性和特异性有限，给患者的精准管理带来巨大挑战。因此，临床实践中迫切需要找到一种及时、准确的诊断方法。本研究纳入了163例疑似IPA的患者。患者的医疗数据从医院信息系统中获取。158例数据完整的患者被分为IPA组（122例，其中58例疑似IPA、19例很可能IPA和45例可能IPA）和非IPA组（36例）。通过针对曲霉属的液滴数字PCR（ddPCR）检测支气管肺泡灌洗液（BALF）或血浆样本中的游离DNA（cfDNA）。总体而言，与真菌培养（44.3%）和涂片检查（10.7%）相比，这种ddPCR检测对IPA诊断的敏感性更高，为50.8%。此外，使用BALF样本时，其在IPA组（73.1%）和疑似IPA亚组（88.2%）中的敏感性高于使用血浆样本时（P<0.01）。它对IPA诊断的特异性高达94.4%，各亚组间cfDNA拷贝数有显著差异（P<0.05）。此外，ddPCR结果与患者出院时的预后相关（P<0.05）。总之，使用BALF样本时，ddPCR检测在IPA诊断中表现良好，尤其是对疑似IPA。ddPCR结果可与临床数据相结合以改善预后预测。
