多技术联合检测指导侵袭性肺真菌病治疗的价值研究

Study on the Value of Combined Detection of Multiple Technologies in Guiding the Treatment of Invasive Pulmonary Fungal Disease (IPFD)

摘要: 目的：探讨真菌培养、G试验、GM试验、数字PCR (dPCR)检测与微生物快速现场评估(M-ROSE)技术联合检测在侵袭性肺真菌病(IPFD)早期诊断的价值。方法：纳入2024年1月至2025年12月于内蒙古自治区人民医院住院的可疑IPFD患者280例，最终临床诊断为IPFD的患者60例，280例患者均留取血清标本行血清G试验、GM试验，留取深部痰液或支气管肺泡灌洗液(BALF)标本行M-ROSE及dPCR检测。对比三种联合方式辅助临床诊断IPFD患者的准确性、特异度和敏感性，并进行ROC曲线分析。采用SPSS 29.0统计软件进行数据分析。结果：真菌培养、G试验、GM试验三种技术联合灵敏度为43.33% (26/60例)，特异度为86.82% (199/220例)，阳性预测值为47.27% (26/55例)，阴性预测值为84.89% (191/225例)；真菌培养、G试验、GM试验、dPCR四种技术联合灵敏度为65% (39/60例)，特异度为78.64% (173/220例)，阳性预测值为45.35% (39/86例)，阴性预测值为78.64% (173/194例)；真菌培养、G试验、GM试验、dPCR检测与M-ROSE五种技术联合的灵敏度为80% (48/60例)，特异度为77.73% (171/220例)，阳性预测值为49.48% (48/97例)，阴性预测值为93.44% (171/183例)。结论：IPFD的发病率逐年增高，早期诊断困难，易出现漏诊和误诊，导致患者预后差。因此，为精准诊疗，多技术联合检测已成IPFD诊断趋势，此研究证实了G试验、GM试验、真菌培养、M-rose及dPCR多技术联合明显通过优势互补实现病原学精准检测，改善患者预后，具有重要临床推广价值。

Abstract: Objective: To investigate the value of combined detection using fungal culture, G test, GM test, digital polymerase chain reaction (dPCR), and Microbiological Rapid On-Site Evaluation (M-ROSE) in the early diagnosis of invasive pulmonary fungal disease (IPFD). Methods: A total of 280 hospitalized patients with suspected IPFD at Inner Mongolia People’s Hospital from January 2024 to December 2025 were enrolled, among whom 60 were finally clinically diagnosed with IPFD. Serum samples were collected from all 280 patients for G test and GM test. Deep sputum or bronchoalveolar lavage fluid (BALF) samples were obtained for M-ROSE and dPCR detection. The accuracy, specificity, and sensitivity of three combined diagnostic strategies for IPFD were compared, and ROC curve analysis was performed. Data was analyzed using SPSS 29.0 software. Results: The combination of fungal culture, G test, and GM test showed a sensitivity of 43.33% (26/60), specificity of 86.82% (199/220), positive predictive value of 47.27% (26/55), and negative predictive value of 84.89% (191/225). The four-method combination (fungal culture, G test, GM test, dPCR) yielded a sensitivity of 65% (39/60), specificity of 78.64% (173/220), positive predictive value of 45.35% (39/86), and negative predictive value of 78.64% (173/194). The five-method combination (fungal culture, G test, GM test, dPCR, M-ROSE) achieved a sensitivity of 80% (48/60), specificity of 77.73% (171/220), positive predictive value of 49.48% (48/97), and negative predictive value of 93.44% (171/183). Conclusion: The incidence of IPFD is increasing annually. Early diagnosis remains challenging, with high rates of missed diagnosis and misdiagnosis, leading to poor prognosis. Therefore, multi-technology combined detection has become a trend in the diagnosis of IPFD to achieve precise diagnosis and treatment. This study confirms that the combined application of G test, GM test, fungal culture, M-ROSE, and dPCR achieves accurate etiological detection through complementary advantages, improves patient prognosis, and has important clinical application value.