宏基因测序检出耶氏肺孢子菌的非HIV患者的临床分析  

Clinical analysis of non-HIV patients with Pneumocystis jirovecii detected by metagenomic sequencing

作　　者：徐如意 曾丽云 陈辉[1] 郑琳[3] 於学婵 虞亦鸣[1] 庄起东 陈众博[1] 邓在春[1] XU Ruyi;ZENG Liyun;CHEN Hui;ZHENG Lin;YU Xuechan;YU Yiming;ZHUANG Qidong;CHEN Zhongbo;DENG Zaichun(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Ningbo University,Key Laboratory of Respiratory Disease of Ningbo,Ningbo 315010,Zhejiang,China;Department of Technology,Hangzhou Matridx Biotechnology Co.,Ltd,Hangzhou 310030,Zhejiang,China;Microbiology Department,the First Affiliated Hospital of Ningbo University,Ningbo 315010,Zhejiang,China)

机构地区：[1]宁波大学附属第一医院呼吸与危重症医学科宁波市呼吸疾病重点实验室,浙江宁波315010 [2]杭州杰毅生物技术有限公司技术部,浙江杭州310030 [3]宁波大学附属第一医院微生物室,浙江宁波315010

出　　处：《中国现代医生》2023年第21期9-14,共6页China Modern Doctor

基　　金：宁波市社会科学发展基金项目(2015C50012);浙江省医药卫生研究基金项目(2016KYB268);宁波大学青苗人才培育基金项目(FYQM-LC-202003);宁波市卫生健康青年技术骨干人才培养基金项目(2020SWSQNGG-05);宁波市医学科技计划项目(2021Y13);浙江省卫生健康科技计划项目(2022RC247)。

摘　　要：目的 总结并分析支气管肺泡灌洗液(bronchoalveolarlavagefluid,BALF)宏基因组二代测序(metagenomic next-generation sequencing,m NGS)检出低序列耶氏肺孢子菌(Pneumocystis jirovecii,PJ)的非HIV患者的危险因素、临床特点、治疗及预后。方法 回顾性分析2018年5月至2022年6月在宁波大学附属第一医院因不明原因肺炎行气管镜检查且BALF-mNGS检出PJ的13例非HIV患者的临床资料。结果 13例患者中,危险因素以使用糖皮质激素最为常见,最常见的症状是咳嗽、咳痰,12例患者有血感染指标异常,影像学特点以两肺弥漫性病变、多发磨玻璃影为主。12例患者接受抗PJ治疗,其中11例患者在治疗期间病情好转,1例因重症感染治疗无效死亡;1例患者未接受抗PJ治疗,在经验性抗感染治疗后好转。结论 经BALF-mNGS检出PJ的非HIV患者临床特点不典型,结合m NGS结果与宿主因素综合判断,有助于早诊、早治,改善患者的预后。Objective To summarize and analyze the risk factors,clinical characteristics,treatment,and prognosis of non-HIV patients with low-sequence Pneumocystis jirovecii(PJ)detected by metagenomic next-generation sequencing(mNGS)of bronchoalveolar lavage fluid(BALF).Methods The clinical data of 13 non-HIV patients with PJ detected by BALF-mNGS who underwent bronchoscopy due to unexplained pneumonia in the First Affiliated Hospital of Ningbo University from May 2018 to June 2022 were retrospectively analyzed.Results Among the 13 patients,the use of glucocorticoids was the most common risk factor,the most common symptom was cough and expectoration,12 patients had abnormal blood infection indicators,and the main imaging features were diffuse lesions in both lungs and multiple ground glass shadows.12 patients received anti-PJ treatment,of which 11 patients were improved during treatment,and one patient died due to ineffective treatment of severe infection.One patient did not receive anti-PJ therapy and improved after empirical anti-infective therapy.Conclusion The clinical characteristics of non-HIV patients with PJ detected by BALF-mNGS are not typical.The combination of mNGS results and host factors is helpful for early diagnosis,treatment and improving the prognosis of patients.

关 键 词：非HIV患者 肺孢子菌肺炎 宏基因组二代测序 低序列 

分 类 号：R519[医药卫生—内科学]