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Abstract：
Invasive pulmonary aspergillosis (IPA) in patients with diabetes mellitus has high incidence, especially in Type 2 diabetes mellitus (T2DM). The aim of this study was to evaluate the diagnostic efficacy of metagenomic next-generation sequencing (mNGS) for IPA in patients with T2DM. A total of 66 patients with T2DM were included, including 21 IPA and 45 non-IPA patients, from January 2022 to December 2022. The demographic characteristics, comorbidities, laboratory test results, antibiotic treatment response, and 30-day mortality rate of patients were analyzed. The diagnostic accuracy of mNGS and conventional methods was compared, including sensitivity, specificity, positive predictive value and negative predictive value. The sensitivity and specificity of mNGS were 66.7% and 100.0%, respectively, which were significantly higher than those of fluorescence staining (42.1% and 100%), serum 1,3-β-D-glucan detection (38.1% and 90.9%), serum galactomannan detection (14.3% and 94.9%) and BALF galactomannan detection (47.3% and 70.7%). Although the sensitivity of BALF culture (75.0%) was higher than that of mNGS (66.7%), the turnover time of mNGS was significantly shorter than that of traditional culture (1.6 days vs. 5.0 days). The sensitivity of mNGS combined with BALF culture reached 100.0%. In addition, mNGS has a stronger ability to detect co-pathogens with IPA. 47.6% of T2DM patients with IPA were adjusted the initial antimicrobial therapy according to the mNGS results. This is the first study to focus on the diagnostic performance of mNGS in IPA infection in T2DM patients. MNGS can be used as a supplement to conventional methods for the diagnosis of IPA in patients with T2DM.
摘要：
侵袭性肺曲霉病(IPA)在糖尿病患者中具有较高的发病率,尤其是2型糖尿病（T2DM）。这项研究的目的是评估宏基因组下一代测序（mNGS）对T2DM患者IPA的诊断功效。共纳入66例T2DM患者，包括21名IPA和45名非IPA患者，从2022年1月到2022年12月。人口特征，合并症,实验室测试结果，抗生素治疗反应，并对患者30天死亡率进行分析。比较了mNGS和常规方法的诊断准确性,包括灵敏度,特异性，阳性预测值和阴性预测值。mNGS的敏感性和特异性分别为66.7%和100.0%,分别,显著高于荧光染色(42.1%和100%),血清1,3-β-D-葡聚糖检测（38.1%和90.9%），血清半乳甘露聚糖检测(14.3%和94.9%)和BALF半乳甘露聚糖检测(47.3%和70.7%)。尽管BALF培养的灵敏度(75.0%)高于mNGS的灵敏度(66.7%),mNGS的周转时间明显短于传统文化(1.6天vs.5.0天）。mNGS联合BALF培养的敏感性达到100.0%。此外,mNGS具有更强的检测与IPA共同病原体的能力。47.6%的T2DM合并IPA患者根据mNGS结果调整初始抗菌治疗。这是首次关注mNGS在T2DM患者IPA感染中的诊断性能的研究。MNGS可作为T2DM患者IPA常规诊断方法的补充。
