实验室传统检测与宏基因组二代测序在肺部真菌感染诊断中的应用价值  

Traditional laboratory detection methods and metagenomic next-generation sequencing in pulmonary fungal infection diagnosis

作　　者：武永莉 鲁炳怀 WU Yongli;LU Binghuai(Graduate School of Chinese Academy of Medical Sciences&Peking Union Medical Collge,Beijing 100730,P.R.China;Laboratory of Clinical Microbiology and Infectious Diseases,Department of Respiratory and Critical Care Medicine,China-Japan Friendship Hospital,Beijing 100029,P.R.China)

机构地区：[1]中国医学科学院北京协和医学院研究生院,北京100730 [2]中日友好医院呼吸与危重症医学科临床微生物与感染实验室,北京100029

出　　处：《华西医学》2022年第8期1128-1133,共6页West China Medical Journal

基　　金：首都卫生发展科研专项(首发2020-2-4062)。

摘　　要：近年来,由于免疫抑制剂的广泛使用,肿瘤、器官移植患者的增多,侵袭性真菌病,特别是肺真菌病的发病率逐年升高。除临床表现、病史、影像学资料外,肺真菌病的诊断主要依赖实验室病原学检测。但真菌培养耗时长、灵敏度低,需要更多的检测手段。近年来宏基因组二代测序(metagenomic next-generation sequencing,mNGS)的出现极大提高了肺部真菌感染的诊断率。相比之下,mNGS能直接从各种临床标本中快速、准确、全面识别真菌,尤其在鉴定非典型真菌的类群方面明显优于传统检测方法,但在样本留取、报告解读及与传统检测方法相结合等方面也存在一些问题。值得肯定的是,随着以上问题不断深入探讨和解决,mNGS必将为肺部真菌感染的病原学诊断提供更有价值的信息。In recent years,due to the extensive usage of immunosuppressant and the rise of patients with cancers and organ transplantation,the incidence rate of invasive fungal infection,especially invasive pulmonary fungal infection,has increased.Besides the clinical manifestations,medical history and imaging,the diagnosis of pulmonary mycosis mainly depends on pathogen detection methods in clinical microbiology laboratory.However,due to the difficulty in fungi culturing and the low sensitivity of smear microscopy,better molecular biology methods are needed.To date,the emergence of metagenomic next-generation sequencing(mNGS)has improved the identification rate of pulmonary fungal infections.mNGS is significantly superior to traditional detection methods in rapid,accurate,and comprehensive determination of fungi from various clinical specimens,especially atypical fungi.However,some problems in mNGS method have to be addressed including sample collection,report interpretation,and its combination with traditional microbiology methods.With the in-depth discussion and solution of the above problems,mNGS will be indispensable to the etiological diagnosis of pulmonary invasive fungal infection.

关 键 词：肺真菌病 宏基因组二代测序 曲霉属 隐球菌属 

分 类 号：R519[医药卫生—内科学] R446.5[医药卫生—临床医学]