基于高通量二代基因测序技术在肾移植术后肺部感染诊治中的应用  

Application of high-throughput second-generation gene sequencing technology in diagnosis and treatment of pulmonary infection after renal transplantation

作　　者：李毅峰 孙建明[1] 许足三[1] 龚烨[1] Li Yifeng;Sun Jianming;Xu Zusan;Gong Ye(Department og Urology,Chenzhou First People′s Hospital Central Hospital,Chenzhou 423000,China)

机构地区：[1]郴州市第一人民医院中心医院泌尿外科,郴州423000

出　　处：《国际泌尿系统杂志》2024年第5期908-912,共5页International Journal of Urology and Nephrology

基　　金：郴州市科学技术局科技发展计划项目(ZDYF2020140)。

摘　　要：目的探讨基于宏基因组学的宏基因组高通量二代基因测序技术(mNGS)在肾移植术后肺部感染诊治方面的应用价值。方法回顾性分析2018年1月至2022年7月期间在郴州市第一人民医院肾移植中心接受治疗的70例肾移植术后肺部感染患者的病史资料。根据是否采用肺泡灌洗液(BALF)的mNGS检测将患者分为mNGS组(32例)和传统组(38例),其中传统组采用传统检测方法,mNGS组的病原体检测方法包括传统检测和BALF的mNGS检测。传统检测包括标本培养、真菌D葡聚糖实验检测、曲霉菌半乳糖甘露糖检测、巨细胞病毒DNA、肺炎支原体血清学试验。比较两组患者的病原学检测阳性率、住院时间、病死率等临床资料。结果mNGS组患者的mNGS检测阳性率明显高于同组传统检测方法和传统组的检测阳性率,差异均有统计学意义(均P<0.05)。mNGS检测方法中的混合性感染检出率高于传统检测方法,差异有统计学意义(P<0.05)。经过治疗,传统组有2例(5.26%)患者死亡,而mNGS组无死亡病例。此外,传统组和mNGS组的住院时间分别为(17.22±8.62)d和(12.58±10.08)d,差异有统计学意义(P<0.05)。结论在肾移植术后肺部感染的诊治中,mNGS检测可提高病原体阳性率,降低住院时间及病死率,对改善肾移植术后受者预后和经济效益有重要的价值。ObjectiveTo explore the effect of high-throughput second-generation gene sequencing(mNGS)in diagnosis and treatment of pulmonary infection after renal transplantation.MethodsThe medical history data of 70 kidney transplant recipients with pulmonary infection who received treatment at the Kidney Transplant Center of Chenzhou First People′s Hospital from January 2018 to July 2022 were retrospectively analyzed.The patients were divided into mNGS group(32 cases)and traditional group(38 cases)according to whether alveolar lavage fluid(BALF)mNGS test was used.Pathogen detection methods in the mNGS group include conventional detection and BALF mNGS detection.Among them,traditional tests include specimen culture,experimental detection of fungal D glucan,detection of Aspergillus galactommannan,cytomegalovirus DNA,and serological test of Mycoplasma pneumoniae.Clinical data such as positive rate of etiological detection,length of stay and fatality rate were compared between the two groups.ResultsThe positive rate of mNGS detection in the mNGS group was significantly higher than that in the traditional detection method and the traditional group,and the differences were statistically significant(all P<0.05).The detection rate of mixed infection in mNGS detection method was higher than that of traditional detection method,and the difference was statistically significant(P<0.05).After treatment,two patients(5.26%)died in the traditional group and none in the mNGS group.In addition,the length of hospitalization in the traditional group and the mNGS group was(17.22±8.62)d and(12.58±10.08)d,respectively,and the difference was statistically significant(P<0.05).ConclusionsIn the diagnosis and treatment of lung infection after kidney transplantation,mNGS detection can increase the positive rate of pathogens,reduce the length of hospital stay and mortality,and has important value in improving the prognosis and economic benefits of recipients after kidney transplantation.

关 键 词：肾移植 感染 肺 基因测序 

分 类 号：R699.2[医药卫生—泌尿科学] R563.1[医药卫生—外科学]