宏基因二代测序技术在异基因造血干细胞移植后结核分枝杆菌感染中的应用
Application of metagenomic next-generation sequencing technology in mycobacterium tuberculosis infection after allogeneic hematopoietic stem cell transplantation
夏晶 1蒋军红 2赵晔 1何雪峰 1金松 1徐婷 1胡晓慧 1吴小津 1马骁 1吴德沛 3陈苏宁 3陈峰1
作者信息
- 1. 苏州大学附属第一医院,江苏省血液研究所,国家血液系统疾病临床医学研究中心(江苏苏州,215000);苏州弘慈血液病医院
- 2. 苏州弘慈血液病医院;苏州大学附属独墅湖医院
- 3. 苏州大学附属第一医院,江苏省血液研究所,国家血液系统疾病临床医学研究中心(江苏苏州,215000)
- 折叠
摘要
目的:探讨宏基因二代测序(metagenomic next-generation sequencing,mNGS)技术在异基因造血干细胞移植后结核分枝杆菌(mycobacterium tuberculosis,MTB)感染中的应用.方法:收集2018年1月至2020年5月采用mNGS诊断的11例异基因造血干细胞移植后MTB感染患者的临床资料,回顾性分析患者的临床特征及治疗转归.结果:11例患者中男6例,女5例;中位年龄45(28～56)岁;结核类型主要为肺结核(9例,81.8％),另外结核性脑膜炎和结核菌血症各1例;移植后并发MTB感染的中位时间为4.1(1.1～12.1)个月.临床表现:以发热和呼吸道症状最常见,其中发热7例,呼吸道症状8例,1例结核性脑膜炎患者表现为发热、头痛和癫痫.实验室检查:11例患者中3例(27.3％)涂片抗酸染色阳性(2例肺泡灌洗液,1例脑脊液);9例(81.8％)外周血T-SPOT阳性;5例(45.5％)Xpert阳性(4例肺泡灌洗液,1例脑脊液);1例(9.1％)外周血MTB-PCR阳性.通过mNGS均检测出MTB序列数(1～154).影像学表现:肺部CT表现为斑片状渗出影7例,纵隔旁团块影1例,多发粟粒状结节影1例,头颅MR1发现1例结核性脑膜炎患者大脑多发结节病灶.预后:经过积极治疗后9例患者获得MTB感染的治愈;1例患者MTB感染经积极治疗后未获得病情控制,死于肺部严重混合感染;另外1例患者死亡原因为MTB感染,总体治愈率为81.8％(9/11).结论:mNGS技术可以明显提高异基因造血干细胞移植后MTB的检出率,为临床早期精准治疗提供重要的病原学依据.
Abstract
Objective:To explore the application of metagenomic next-generation sequencing(mNGS)technol-ogy in mycobacterium tuberculosis(MTB)infection after allogeneic hematopoietic stem cell transplantation.Methods:The clinical data of 11 patients with MTB infection after allogeneic hematopoietic stem cell transplanta-tion diagnosed by mNGS from January 2018 to May 2020 were retrospectively analyzed.Results:Of the 11 pa-tients,there were 6 males and 5 females.The median age was 45(28-56)years old.The main type of tuberculosis was pulmonary tuberculosis(9 cases,81.8％).Other types included 1 case of tuberculous meningitis and 1 case of tuberculous bacteremia.The median duration of MTB presentation after transplantation was 4.1 months(range 1.1-12.1 months).The clinical manifestations were mainly fever and respiratory symptoms,including 7 cases of fever,8 cases of respiratory symptoms,and 1 case of tuberculous meningitis with fever,headache and epilepsy.Laboratory examination:Three out of 11 patients(27.3％)showed positive acid-fast staining on smears(2 cases of bronchoalveolar lavage fluid and 1 case of cerebrospinal fluid);9 cases(81.8％)were T-SPOT positive in periph-eral blood;5 cases(45.5％)were Xpert positive(4 cases of bronchoalveolar lavage fluid and 1 case of cerebrospinal fluid);1 case(9.1％)had positive peripheral blood MTB-PCR.The MTB sequence number of all the patients were detected by mNGS(between 1-154).Image findings:The chest CT showed patched shadow in 7 cases,mass shadow near mediastinum in 1 case,multiple miliary nodular shadow in 1 case.Brain MRI revealed multiple nodu-lar lesions in one patient with tuberculous meningitis.After active treatment,9 patients were cured of MTB infec-tion,and 1 patient died of severe mixed infection in the lungs without control,the other one died of MTB infec-tion,with an overall cure rate of 81.8％(9/11).Conclusion:mNGS technology can significantly improve the de-tection rate of MTB after allogeneic hematopoietic stem cell transplantation,providing important pathogenic basis for early and precise clinical treatment.
关键词
结核分枝杆菌感染/异基因造血干细胞移植/宏基因二代测序/诊断Key words
mycobacterium tuberculosis/allogeneic hematopoietic stem cell transplantation/metagenomic next-generation sequencing/diagnosis引用本文复制引用
基金项目
国家重点研发计划(2019YFC0840604)
江苏省重点研发计划(BE2019798)
江苏省科教强卫工程-临床医学中心(YXZXA2016002)
出版年
2024
NETL
NSTL
万方数据