支气管肺泡灌洗液宏基因组二代测序在非中性粒细胞减少肺曲霉感染中的诊治价值  

The identified and therapeutic value of metagenomic next-sequencing of bronchoalveolar lavage fluid in non-neutropenic pulmonary aspergillus infection

作　　者：周群[1] 费黎明[1] 尤青海[1] ZHOU Qun;FEI Liming;YOU Qinghai(Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院呼吸与危重症医学科,安徽合肥230022

出　　处：《临床肺科杂志》2023年第7期1009-1014,共6页Journal of Clinical Pulmonary Medicine

基　　金：安徽省高校自然科学研究重点项目(No.KJ2021A0302)。

摘　　要：目的探讨支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)宏基因组二代测序(metagenomic next-generation sequencing,mNGS)在非中性粒细胞减少肺曲霉感染中的鉴别优势及治疗指导价值。方法回顾性研究2021年11月至2022年12月的32例非中性粒细胞减少患者的临床资料,其BALF的mNGS均提示真菌,17例为肺曲霉感染,15例为非肺曲霉感染。观察非中性粒细胞减少肺曲霉感染的临床特性,对比mNGS和常规方法的检测阳性率,评估mNGS对治疗的指导价值。结果与非肺曲霉感染组相比,肺曲霉感染组更多表现为咯血或痰血(23.5%vs 0.0%,P<0.05),更多的患者接受全身皮质类固醇激素治疗(76.5%vs 40.0%,P<0.05)。两组BALF的mNGS检测阳性率均明显高于传统病原学方法(P<0.05)。肺曲霉感染组BALF的mNGS检测阳性率明显高于培养及GM试验(P均<0.001),可鉴定出94.1%共病原,其中共细菌、真菌和病毒的混合感染最多见(23.5%)。88.2%的肺曲霉感染患者根据mNGS结果调整了抗感染治疗方案,76.5%的患者添加抗曲霉菌药物,2例患者通过动态监测mNGS确定了抗曲霉治疗疗程。结论BALF的mNGS是鉴定非中性粒细胞减少肺曲霉感染的高效实用手段,在发现共病原及调整治疗方案上尤具优势。Objective To investigate the value of metagenomic next-generation sequencing(mNGS)of bronchoalveolar lavage fluid(BALF)in the identification and treatment of non-neutropenic pulmonary aspergillus infection.Methods A retrospective study was conducted on 32 non-neutropenia patients from November 2021 to December 2022.The mNGS of BALF in all patients indicated fungus,with 17 cases of pulmonary aspergillus infection and 15 cases of non-pulmonary aspergillus infection.The clinical characteristics of non-neutropenic pulmonary aspergillus were observed.The positive rate of BALF mNGS was compared with that of the conventional methods.The therapeutic guiding value of mNGS was evaluated.Results The pulmonary aspergillus infection group showed more hemoptysis or bloody sputum than the non-pulmonary aspergillus infection group(23.5%vs 0.0%,P<0.05).More patients in the pulmonary aspergillus infection group received systemic corticosteroid therapy(76.5%vs 40.0%,P<0.05).The positive rate of BALF mNGS in both groups was significantly higher than that in conventional etiological methods(P<0.05).In the non-neutropenic aspergillus infection group,the detection efficiency of mNGS in BALF was significantly better than that in culture and GM(P<0.001),and mNGS had unique advantages in the detection of co-pathogens(94.1%),with co-bacteria,fungi,and viruses being most common in the non-neutropenic aspergillus infection group(23.5%).According to the results of mNGS,88.2%of patients adjusted the antimicrobial therapy,anti-aspergillus drugs were added to 76.5%of the patients.The course of anti-Aspergillus treatment was guided by mNGS of BALF in 2 patients.Conclusion The mNGS of BALF is an effective and practical method for the diagnosis of non-neutropenic pulmonary aspergillus infection,especially in the detection of co-pathogens and the adjustment of treatment options.

关 键 词：宏基因组二代测序 支气管肺泡灌洗液 传统病原学方法 非中性粒细胞减少肺曲霉感染 

分 类 号：R519[医药卫生—内科学]