宏基因二代测序对结缔组织病并发免疫抑制宿主肺炎患者的病原学分析  

Etiological analysis of connective tissue disease complicated with immunosuppressive host pneumonia by metagenomics next-generation sequencing

作　　者：张安兵[1] 袁小玲[1] 夏秀琼[1] 吕燕华[1] 张丹丹 梁剑平[1] ZHANG An-bing;YUAN Xiao-ling;XIA Xiu-qiong;L Yan-hua;ZHANG Dan-dan;LIANG Jian-ping(Department of Respiratory and Critical Care Medicine,People′s Hospital of Zhongshan City,Zhongshan,Guangdong528400,China)

机构地区：[1]中山市人民医院呼吸与危重症医学科,广东中山528400

出　　处：《临床肺科杂志》2022年第8期1229-1233,共5页Journal of Clinical Pulmonary Medicine

基　　金：广东省医学科学技术研究基金(No.C2019032);中山市医学科研项目(No.2021J096)。

摘　　要：目的探讨宏基因二代测序(mNGS)应用于结缔组织病并发免疫抑制宿主肺炎患者的病原学分布,指导该类患者的经验性抗感染治疗。方法收集2019年1月至2021年7月在我院确诊结缔组织病并发免疫抑制宿主肺炎患者的临床资料,回顾性分析肺泡灌洗液mNGS及传统检测方法病原学结果。结果32例患者中有28例肺泡灌洗液mNGS检测阳性(检出率87.50%,95%CI为1.354~16.936),其中细菌15例(46.88%),真菌13例(40.63%),病毒7例(21.88%,该7例病毒感染均为与细菌或真菌的混合感染),真菌、病毒感染者激素、免疫抑制剂使用时间均超过3个月。32例患者中有19例患者传统病原学检测阳性(检出率59.37%,95%CI为0.303~2.829)。肺泡灌洗液mNGS病原学检测阳性率明显高于传统检测方法(87.50%vs 59.37%,χ^(2)=6.488,P=0.01)。结论结缔组织病并发免疫抑制宿主肺炎患者感染病原体占比由高到低依次为细菌、真菌、病毒,革兰阴性菌、耶氏肺孢子菌、巨细胞病毒感染者较为常见。mNGS可显著提高该类患者病原体检出率,有效指导抗感染治疗。Objective To investigate the etiological distribution of patients who got connective tissue disease with immunosuppressive host pneumonia by metagenomics next-generation sequencing(mNGS),and to guide the empirical anti-infective treatment of these patients.Methods The clinical data of patients who got connective tissue disease with immunosuppressive host pneumonia in our hospital from January 2019 to July 2021 were collected,and the etiological results of mNGS in alveolar lavage fluid and traditional etiological detection methods were analyzed retrospectively.Results Among the 32 patients,28 patients were tested positive for mNGS in alveolar lavage fluid(87.50%,95%CI:1.354~16.936),including 15 cases of bacteria(46.88%),13 cases of fungi(40.63%)and 7 cases of viruses(21.88%).The 7 viral infections were mixed infection with bacteria or fungi.The use time of glucocorticoid and immunosuppressant in fungi and virus infected patients was more than 3 months.19 of the 32 patients were tested positive by traditional etiological detection(59.37%,95%CI:0.303~2.829).The positive rate of mNGS in alveolar lavage fluid was significantly higher than that of traditional methods(87.5%vs 59.37%,χ^(2)=6.488,P=0.01).Conclusion The proportion pathogens in patients who get connective tissue disease complicated with immunosuppressive host pneumonia are bacteria,fungi and viruses from high to low,and gram-negative bacteria,yersinia pneumocystis and cytomegalovirus are more common.mNGS can significantly improve the detection rate of pathogens in these patients,and effectively guide anti-infection treatment.

关 键 词：结缔组织病 宏基因二代测序 免疫抑制宿主 肺炎 肺泡灌洗 

分 类 号：R593.2[医药卫生—内科学] R563.1[医药卫生—临床医学] R446.5