宏基因组二代测序在免疫抑制合并重症肺炎患者病原体分布中的应用  

Metagenomic next-generation sequencing in the distribution of pathogens in severe pneumonia patients combined with immunosuppression

作　　者：孙浩[1] 孙博文 薛楠楠 梁方成 安子越 张国俊[2] 王华启[2] SUN Hao;SUN Bowen;XUE Nannan;LIANG Fangcheng;AN Ziyue;ZHANG Guojun;WANG Huaqi(Department of radiation oncology,the first af filiated hospital of zhengzhou university,zhengzhou,henan 450052,China;Department of respiratory and critical care medicine,the first affiliated hospital of zhengzhou university,zhengzhou,henan 450052,China;Cancer center,the first affiliated hospital of zhengzhou university,zhengzhou,henan 450052,China)

机构地区：[1]郑州大学第一附属医院放疗科,河南郑州州450052 [2]郑州大学第一附属医院呼吸与危重症医学科,河南郑州450052 [3]郑州大学第一附属医院肿瘤中心,河南郑州450052

出　　处：《中华实用诊断与治疗杂志》2024年第10期1040-1045,共6页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(81972182)。

摘　　要：目的应用宏基因组二代测序(mNGS)分析不同类型免疫抑制合并重症肺炎患者的病原体分布特点,为临床治疗提供依据。方法2021年1月—2022年1月郑州大学第一附属医院诊治免疫抑制合并重症肺炎患者113例,根据免疫抑制类型分为长期使用激素或免疫抑制剂组(长期组)71例和其他类型组(其他组)42例,2组均行纤维支气管镜检查,收集支气管肺泡灌洗液行mNGS检测,分析2组病原体感染类型及病原体分布特点。73例患者根据mNGS结果调整抗感染治疗方案,观察治疗结局。结果2组肺部混合感染均常见,长期组mNGS检出的细菌、真菌、病毒分别主要为鲍曼不动杆菌、耶氏肺孢子菌、人类疱疹病毒4型;其他组mNGS检出的细菌、真菌、病毒分别主要为鲍曼不动杆菌、曲霉菌、人类疱疹病毒1型。长期组病毒+真菌检出率(25.4%)高于其他组(7.1%)(χ^(2)=4.499,P=0.034),细菌+真菌、细菌+真菌+病毒检出率(7.0%、19.7%)均低于其他组(21.4%、38.1%)(χ^(2)=4.527,P=0.033;χ^(2)=4.135,P=0.043),细菌+病毒检出率(9.9%)与其他组(9.5%)比较差异无统计学意义(χ^(2)=0.007,P=0.935),单病原体(细菌、真菌、病毒、非典型病原体)检出率(11.3%、14.1%、1.4%、2.8%)与其他组(11.9%、2.4%、0、2.4%)比较差异均无统计学意义(χ^(2)=0.005,P=0.945;χ^(2)=2.232,P=0.135;χ^(2)=0.587,P=0.443;χ^(2)=0.021,P=0.886)。长期组耶氏肺孢子菌检出率(46.7%)高于其他组(28.0%)(χ^(2)=5.130,P=0.023),鲍曼不动杆菌、肺炎克雷伯菌检出率(11.3%、5.6%)均低于其他组(23.5%、14.7%)(χ^(2)=25.230,P<0.001;χ^(2)=26.440,P<0.001)。73例患者根据mNGS结果调整抗感染治疗方案后好转出院48例,病情恶化自动出院20例,死亡5例。结论不同类型免疫抑制合并重症肺炎患者常见感染类型均为混合感染;与其他免疫抑制类型相比,长期使用激素或免疫抑制剂患者感染耶氏肺孢子菌的风险较高,感染鲍曼不动杆菌和肺炎克雷伯�Objective To analyze the distribution characteristics of pathogens in severe pneumonia patients with different types of immunosuppression using metagenomic next-generation sequencing(mNGS),and to provide a basis for clinical treatment.Methods From January 2021 to January 2022,113 patients with immunosuppression-associated severe pneumonia were treated in the First Affiliated Hospital of Zhengzhou University,among whom 71 patients had the history of long-term glucocorticoid or immunosuppressant therapy(long-term group)and the other 42 patients had other types of immunosuppression(other-type group).Both groups were performed fiberoptic bronchoscopy examination,and the bronchoalveolar lavage fluid samples were harvested for mNGS to analyze the pathogen infection types and distribution characteristics.The anti-infective therapy regimen was adjusted based on mNGS results in 73 patients,and the coutcomes were observed.Results Mixed lung infections were common in both groups,with Acinetobacter baumannii,Pneumocystis jirovecii,and Human Herpesvirus 4 as the bacteria,fungi,and viruses detected by mNGS in long-term group,and Acinetobacter baumannii,Aspergillus,and Human Herpesvirus 1 in other-type group.The detection rate of viruses+fungi was higher in long-term group(25.4%)than that in other-type group(7.1%)(χ^(2)=4.499,P=0.034),the detection rates of bacteria+fungi and bacteria+fungi+viruses were lower in long-term group(7.0%,19.7%)than those in other-type group(21.4%,38.1%)(χ^(2)=4.527,P=0.033;χ^(2)=4.135,P=0.043),there were no significant differences in the detection rates of bacteria+viruses,single pathogens(bacteria,viruses,fungi,atypical pathogens)between long-term group(9.9%,11,3%,14.1%,1.4%,2.8%)and other-type group(9.5%,11.9%,2.4%,0,2.4%)(χ^(2)=0.007,P=0.935;χ^(2)=0.005,P=0.945;χ^(2)=2.232,P=0.135;χ^(2)=0.587,P=0.443;χ^(2)=0.021,P=0.886).The detection rate of Pneumocystis jirovecii was higher in long-term group(46.67%)than that in other-type group(28.0%)(χ^(2)=5.130,P=0.023),while the detection rates of

关 键 词：重症肺炎 免疫抑制 宏基因组二代测序 病原体 

分 类 号：R563.1[医药卫生—呼吸系统]