宏基因组二代测序在异基因造血干细胞移植术后肺孢子菌肺炎和免疫相关肺炎诊断中的临床价值  

Clinical value of metagenomic next generation sequencing in the diagnosis of Pneumocystis pneumonia and immune-related pneumonia following allogeneic hematopoietic stem cell transplantation

作　　者：王宇 叶雪梅 毛妍 蒲文琦 黄晓兵[2] 陈璐[2] 杨曦 邓利平[3] 杜文飞 WANG Yu;YE Xuemei;MAO Yan;PU Wenqi;HUANG Xiaobing;CHEN Lu;YANG Xi;DENG Liping;DU Wenfei(Department of Hematology,Chengdu Dongli Hospital,Sichuan Provincial People's Hospital Medical Group,Chengdu 610000,China)

机构地区：[1]四川省人民医院医疗集团(成都东篱医院)血液科,成都610000 [2]电子科技大学附属医院(四川省人民医院)血液科 [3]成都市龙泉驿区第一人民医院内科 [4]中国人民解放军联勤保障部队第906医院内科

出　　处：《中国感染与化疗杂志》2023年第2期156-160,共5页Chinese Journal of Infection and Chemotherapy

基　　金：四川省科技厅计划项目(2018JY0615);四川省科技计划项目(2021YJ0189)。

摘　　要：目的探索宏基因组二代测序(mNGS)在异基因造血干细胞移植术后肺孢子菌肺炎和免疫相关肺炎诊断中的临床价值。方法纳入2019年8月—2021年8月于四川省人民医院医疗集团(成都东篱医院)行异基因造血干细胞移植术后出现肺部弥漫性、多发性病灶的患者。回顾性分析肺泡灌洗液的mNGS结果和传统病原学检测针对耶氏肺孢子菌的检出率、免疫相关肺炎的发生率,并总结临床特征与mNGS结果的相关性。结果24例感染患者的mNGS结果中,有5例为单纯病毒,4例为病毒合并细菌、真菌,排除这9例患者。在可评估15例患者中8例(53.3%)检出肺孢子菌,均经标准剂量复方磺胺甲唑为基础的抗肺孢子菌肺炎治疗后康复;7例(46.7%)未检出明确病原菌的患者中,5例(33.3%)经过标准的糖皮质激素为基础的免疫抑制剂治疗后康复,2例(13.3%)经标准剂量复方磺胺甲唑为基础的抗肺孢子菌肺炎治疗后康复。结论针对异基因造血干细胞移植后临床难以鉴别的肺部弥漫性、多发性病变,采用肺泡灌洗液mNGS的阳性结果可以精准、快速筛选出肺孢子菌肺炎患者,而其阴性结果可以在较大程度上提示免疫相关肺炎的可能性,具有很好的鉴别诊断意义。Objective To explore the clinical value of metagenome next-generation sequencing(mNGS)in the diagnosis of Pneumocystis pneumonia and immune-related pneumonia following allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods From August 2019 to August 2021,24 patients were identified with diffuse and multiple pulmonary lesions after alloHSCT in our center.The mNGS results of bronchial alveolar lavage fluid(BALF),the detection rate of Pneumocystis jirovecii,and the incidence of immune-related pneumonia were analyzed retrospectively.The correlation between clinical characteristics and data from mNGS was examined.Results The mNGS analysis identified virus alone in the samples of 5 patients,and virus,bacteria and fungi in the samples of 4 patients.The 9 patients were excluded.Therefore,15 patients were evaluable.P.jirovecii was detected from the samples in 8 of the 15 patients(53.3%),who recovered after treatment with standarddose trimethoprim-sulfamethoxazole(TMP-SMZ)tablets.No pathogen was identified in the remaining 7 patients(46.7%),5(33.3%)of which recovered after standard glucocorticoid-based immunosuppressive therapy,and 2(13.3%)recovered after treatment with standard-dose TMP-SMZ tablets.Conclusions The diffuse and multiple lung lesions following allo-HSCT are too complex to be diagnosed in clinical practice.BALF mNGS plays an important role in differentiating Pneumocystis pneumonia from immune-related pneumonia.P.jirovecii-positive mNGS result can accurately and quickly identify the patients with Pneumocystis pneumonia,while P.jirovecii-negative mNGS result may suggest higher possibility of immune-related pneumonia.

关 键 词：宏基因组二代测序 肺孢子菌肺炎 免疫相关肺炎 异基因造血干细胞移植 

分 类 号：R446[医药卫生—诊断学] R519[医药卫生—临床医学]