宏基因组测序技术对隐球菌感染的诊断价值  

Value of metagenomic next-generation sequencing in diagnosis of Cryptococcus infection

作　　者：王启彤 周永召[3] 黄敏 白雪 程乐 WANG Qi-tong;ZHOU Yong-zhao;HUANG Min;BAI Xue;CHENG Le(Dali University,Dali,Yunnan 671000,China;不详)

机构地区：[1]大理大学基础医学院,云南大理671000 [2]云南华大基因研究院,云南昆明650106 [3]四川大学华西医院全程管理中心,四川成都610041

出　　处：《中华医院感染学杂志》2024年第2期220-225,共6页Chinese Journal of Nosocomiology

基　　金：四川省重点研发项目(2021YFS0368)。

摘　　要：目的探讨宏基因组测序技术(mNGS)在隐球菌感染中的诊断价值。方法回顾性收集四川大学华西医院56例mNGS查见隐球菌核酸序列的疑似隐球菌感染患者的临床资料及病原体检出结果,对以上数据进行整理分析。结果本研究共纳入56例患者,男性32例,女性24例,年龄20~80岁,其中合并危险因素患者47例占83.93%,56例患者中最终诊断考虑为隐球菌感染50例占89.29%,全部患者检出隐球菌(属)核酸序列,53例占94.64%检出新型隐球菌;肺泡灌洗液、肺穿刺组织和脑脊液mNGS检测隐球菌感染与临床诊断的符合率分别为73.33%、100.00%和93.10%,其中肺穿刺组织的mNGS检测符合率高于组织病理学检查的诊断符合率(P<0.001);除隐球菌外,34例占60.71%患者标本使用mNGS检测检出其他病原体;Spearman相关性分析示患者血清隐球菌抗原滴度与脑脊液mNGS隐球菌(属)核酸序列数呈线性正相关(r=0.609,P=0.005)。结论mNGS可以有效识别隐球菌感染,适用于肺穿刺组织样本的检测,可弥补传统检测方法尤其是组织病理学检查的不足;相对于隐球菌性脑膜炎,mNGS对于隐球菌肺炎的诊断价值更高。OBJECTIVE To explore the value of metagenomic next-generation sequencing(mNGS)in diagnosis of Cryptococcus infection.METHODS The clinical data were retrospectively collected from 56 patients who had sus-pected Cryptococcus infection and were detected with nucleotide sequence of Cryptococcus by mNGS in West Chi-na Hospital,Sichuan University,and the result of culture of pathogens was identified.The above data were sta-tistically analyzed.RESULTS A total of 56 patients,including 32 male patients and 24 female patients,were enrolled in the study.The enrolled patients were aged between 20 and 80 years.Totally 47 patients were complicated by risk factors,accounting for 83.93%.50 of 56 patients were finally diagnosed with Cryptococcus infection,accounting for 89.29%,all of the patients were detected with the nucleotide sequences of Cryptococcus species,and 53(94.64%)were detected with Cryptococcus neoformans.The concordance rates of mNGS for bronchoalveolar lavage,lung puncture tissues and cerebro-spinal fluid specimens with the clinical diagnosis were 73.33%,100.00%and 93.10%,respectively;the concordance rate of mNGS for lung puncture tissues was higher than that of the histopathological examination(P<0.001).Besides Cryptococcus,the specimens of 34(60.71%)were detected with other pathogens by mNGS.Spearman correlation anal-ysis showed that there was a linear positive correlation between the serum antigen titer of Cryptococcus and the nucleotide sequences of Cryptococcus(genus)in cerebrospinal fluid specimens detected by mNGS(r=0.609,P=0.005).CONCLUSION mNGS can effectively identify the Cryptococcus infection,it is suitable for the detection of sam-ples of lung puncture tissues and can make up for the deficiencies of histopathological examination.The mNGS has higher value in diagnosis of cryptococcal pneumonia than in diagnosis of cryptococcal meningitis.

关 键 词：宏基因组测序技术 隐球菌感染 隐球菌肺炎 隐球菌性脑膜炎 诊断价值 

分 类 号：R446.5[医药卫生—诊断学]