Application of metagenomic next-generation sequencing in the diagnosis and treatment of Pneumocystis jirovecii pneumonia in non-HIV-infected patients
扫码查看
点击上方二维码区域，可以放大扫码查看
原文链接
NETL
NSTL
万方数据
目的:探讨宏基因组二代测序(mNGS)在非人类免疫缺陷病毒(HIV)感染患者中耶氏肺孢子菌肺炎(PJP)的诊断价值和其对治疗的指导价值.方法:采用回顾性研究方法,共纳入武汉大学中南医院2017年1月至2022年7月非HIV感染PJP患者73例和诊断为非PJP患者70例.分析了支气管肺泡灌洗液(BALF)中耶氏肺孢子菌(PJ)和其他共病原体情况,以临床复合诊断为参考标准,比较mNGS、聚合酶链式反应(PCR)和血清1,3-β-D-葡聚糖(BDG)在PJP中的诊断效能,将纳入研究的PJP患者根据是否行mNGS分为行mNGS组和未行mNGS组,通过非参数秩和检验对比两组治疗情况.结果:本研究共纳入非HIV感染PJP患者73例,其中46例患者行mNGS检测,统计分析结果显示,相较于PCR、BDG,mNGS在诊断非HIV感染PJP的灵敏度(97.8％)和特异度(95.2％)更高.同时,mNGS在混合感染的检出率明显高于传统病原学检测(87.0％vs 63.0％,P=0.018),其中以白色念珠菌、人类疱疹病毒5型(CMV)、人类疱疹病毒1型(HSV1)最为常见.并且,在46例患者mNGS结果回报后,71.7％的PJP患者对最初的治疗方案进行了调整,其中57.6％患者经调整治疗方案后好转出院.与未行mNGS检测的非HIV感染PJP患者相比,行mNGS的患者住院时间更短[16(9,24)d vs 26(16,41)d],抗生素疗程更短[12(6,16)dvs 20(11,31)d],差异均有统计学意义(均P＜0.05).结论:mNGS对非HIV感染PJP的诊断效能高,且对于共病原体检出具有更好的性能,对临床诊断和指导针对性抗感染药物治疗具有一定的价值.
Objective:To investigate the diagnostic value of metagenomic next-generation sequencing(mNGS)in Pneumocystis jirovecii pneumonia(PJP)in non-human immunodeficiency virus(HIV)-in fected patients and its guiding value for treatment.Methods:PJP patients were divided into mNGS group and non-mNGS group according to whether they received mNGS or not,and the treatment of the two groups was compared by non-parametric rank test.Results:A total of 73 patients with non-HIV infection PJP were included in this study,among which 46 patients were tested for mNGS.Statistical analysis results showed that mNGS had higher sensitivity(97.8％)and specificity(95.2％)in the diagnosis of non-HIV-infected PJP as compared with PCR and BDG.Meanwhile,the detection rate of mNGS in mixed infection was significantly higher than that of traditional etiological detection(87.0％vs 63.0％,P=0.018),among which candida albicans,human herpesvirus type 5(CMV)and human herpesvirus type 1(HSV1)were the most common.Moreover,after the mNGS results of 46 patients were received,the initial treatment regimen was adjusted in 71.7％of the PJP patients,and 57.6％of the patients improved and were discharged after adjusting the treatment plan.Com-pared with non-HIV-infected PJP patients who did not undergo mNGS testing,the patients who re-ceived mNGS had a shorter length of hospital stay(16(9,24)d vs 26(16,41)d)and a shorter course of antibiotics(12(6,16)d vs 20(11,31)d)with statistically significant difference(all P＜0.05).Conclu-sion:mNGS has high diagnostic efficacy in non-HIV PJP and has better performance for the detection of co-pathogens,which has value for clinical diagnosis and guidance of targeted anti-infective drug treatment.
NETL
NSTL
万方数据
