宏基因组二代测序在非HIV感染型肺孢子菌肺炎中的应用研究  

Application of metagenomics next-generation sequencing in non-HIV infected pneumocystis jirovecii pneumonia

作　　者：陈佳怡 梁晓[1] 夏铵冬 杨芸[1] 袁兵[2] 耿嘉蔚[1] CHEN Jiayi;LIANG Xiao;XIA Andong;YANG Yun;YUAN Bin;GENG Jiawei(Department of Infectious Diseases and Hepatic Diseases,Yunnan Provincial First People’s Hospital/Affiliated Hospital of Kunming University of Science and Technology,Kunming,Yunnan 650032,China;Department of Pulmonary and Critical Care Medicine,Yunnan Provincial First People’s Hospital/Affiliated Hospital of Kunming University of Science and Technology,Kunming,Yunnan 650032,China)

机构地区：[1]云南省第一人民医院/昆明理工大学附属医院感染性疾病及肝病科,昆明650032 [2]云南省第一人民医院/昆明理工大学附属医院呼吸与危重症医学科,昆明650032

出　　处：《重庆医学》2023年第1期91-96,共6页Chongqing medicine

基　　金：昆明市科技计划项目(2020-1-H-020);云南(昆明)张文宏专家工作站(YSZJGZZ-2020051)。

摘　　要：目的分析宏基因组二代测序(mNGS)在非人类免疫缺陷病毒(HIV)感染型肺孢子菌肺炎(PJP)病原学诊断中的价值和特点。方法选取2019年4月至2021年1月在该院收治的18例非HIV感染型PJP患者,收集mNGS结果及临床资料,采用SPSS25.0进行统计分析,两组间比较采用Mann-Whitney U检验,测序数据与部分临床指标进行Spearman相关分析。结果18例PJP患者送检16例支气管肺泡灌洗液(BALF)和2例血标本mNGS中均检出Pj序列,17例标本Pj序列相对丰度在85%以上,Pj序列数在所有微生物种间排名1~14;未发现Pj序列数与发病时间、氧合指数、CD4^(+)T淋巴细胞计数相关(rs=-0.131,-0.129,-0.040,P>0.05),与是否经验性抗Pj治疗(P=0.158)及是否发生院内死亡(P=0.426)不相关。所有BALF中均检出细菌序列并报告了可疑致病菌,血标本中未检出细菌序列;14例检出病毒序列,最常见为人类β疱疹病毒5型(9例)。所用患者接受磺胺甲噁唑/甲氧苄啶或联用棘白菌素类药物抗Pj治疗,治疗后影像学改善明显,3例发生院内死亡。结论在非HIV感染型PJP病例中mNGS有良好的检测能力,条件允许时尽量选择下呼吸道标本送检以获得更全面的病原学信息。Objective To explore the value and characteristics of metagenomic next-generation sequencing(mNGS)technology in the pathogenic diagnosis of non-HIV-infected pneumocystis jirovecii pneumonia(PJP).Methods Eighteen cases of non-HIV infected PJP treated in this hospital from April 2019 to January 2021 were selected.The mNGS results and clinical data were collected and statistically analyzed by SPSS 25.0.The Mann-Whitney U test was used to compare the data between the two groups.The sequencing data and some clinical indicators conducted the Spearman correlation analysis.Results The Pj sequence was detected in 16 cases of bronchoalveolar lavage fluid(BALF)and 2 cases of blood samples submitted from 18 cases of PJP.The relative abundance of Pj sequence in 17 samples was above 85%,the number of Pj sequences ranked 1-14 among all microbial species;no correlation was found between the Pj sequence number and the onset time,oxygenation index or CD4^(+) T lymphocyte count(rs=-0.131,-0.129,-0.040,P>0.05)and the Pj sequence number had no correlation with the anti-Pj empiric treatment(P=0.158)and whether the hospital death occurrence(P=0.426).The bacterial sequences were detected in all BALFs and the suspected pathogenic bacteria were reported.No bacterial sequence was detected in blood samples.The viral sequences were detected in 14 cases,the most common was human beta herpesvirus type 5(9 cases).All patients received the anti-Pj treatment of sulfamethoxazole/trimethoprim or its combination medication with echinocandin.The imaging improvement was obvious after treatment.Three cases died in hospital.Conclusion mNGS has good detection capability in non-HIV infected PJP cases.When the conditions permit,the specimens of lower respiratory tract should be selected for examination to obtain more comprehensive etiological information.

关 键 词：肺孢子菌肺炎 耶氏肺孢子菌 宏基因组二代测序 

分 类 号：R563.1[医药卫生—呼吸系统]