宏基因组二代测序在非HIV感染的耶氏肺孢子菌肺炎中的诊疗价值  

Diagnostic and therapeutic value of metagenomic next-generation sequencing in pneumocystis jirovecii pneumonia in non-HIV immunosuppressed patients

作　　者：杨佳 林晨晨 罗培园 文菲菲 武旋 刘红梅 张茜茜 YANG Jia;LIN Chen-chen;LUO Pei-yuan;WEN Fei-fei;WU Xuan;LIU Hong-mei;ZHANG Qian-qian(Department of Respiratory and Critical Care Medicine,Henan Provincial People's Hospital,People's Hospital of Zhengzhou University,Zhengzhou 450003,China;Department of Respiratory and Critical Care Medicine,Henan Provincial People's Hospital,People's Hospital of Henan University,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院,郑州大学人民医院呼吸与危重症医学科,郑州450003 [2]河南省人民医院,河南大学人民医院呼吸与危重症医学科,郑州450003

出　　处：《医药论坛杂志》2025年第1期1-7,共7页Journal of Medical Forum

基　　金：郑州市协同创新重大专项(518-23240003/518-23240004)。

摘　　要：目的探讨宏基因组二代测序(metagenomic next-generation sequencing,mNGS)技术对于非HIV感染的耶氏肺孢子菌肺炎(Pneumocystis jirovecii pneumonia,PJP)在诊断灵敏度、特异度和混合感染方面的价值。方法采用回顾性研究方法,以临床复合诊断为标准,纳入河南省人民医院2022年7月至2024年7月收治的78例非HIV感染PJP和81例非PJP肺炎患者,比较两组患者临床特征的差异,比较mNGS与血清1,3-β-D葡聚糖[serum(1,3)-β-D-glucan,BDG]检测、六胺银染色在PJP中的诊断效能,进一步分析了PJP患者混合感染中病原体分布情况。结果PJP组中合并基础疾病、有激素和免疫抑制剂应用史的患者比例明显高于非PJP组(P<0.001)。mNGS诊断PJP的灵敏度为100%,明显高于六胺银染色(16.7%)和血清BDG(24.4%),差异有统计学意义(P<0.05);特异度为86.4%,低于六胺银染色(100%),与血清BDG检测(91.4%)差异无统计学意义(P>0.05)。绝大部分(93%)PJP患者为混合性感染,PJP同时合并细菌、真菌和病毒感染的病例最多(26例,33%)。结论mNGS在PJP的诊断中具有良好的灵敏度和特异度,且能快速识别混合感染中的共致病菌,有助于PJP的早期、快速、准确诊断和精准抗感染治疗。Objective To explore the value of next-generation metagenomic sequencing(mNGS)in diagnostic sensitivity,specificity and co-infection of non-HIV infected pneumocystis jirovecii pneumonia(PJP).Methods Totally 159 patients were enrolled in this retrospective study,including 78 patients with non-HIV PJP and 81 patients with non-PJP pneumonia treated at Henan Provincial People's Hospital from July 2022 to July 2024.Clinical characteristics were compared between the two groups.Using clinical composite diagnosis as the reference standard,we assessed the diagnostic performance of mNGS against Gomori methenamine silver staining and serum(1,3)-β-D-glucan(BDG)assays.The distribution of pathogens in patients with mixed infections was further analyzed.Results The proportion of patients with underlying diseases and a history of corticosteroid or immunosuppressant use was significantly higher in the PJP group compared to the non-PJP group(P<0.001).The sensitivity of mNGS for diagnosing PJP was 100%,which was significantly greater than that of GMS staining(16.7%)and serum BDG(24.4%)(P<0.05).The specificity of mNGS was 86.4%,which was lower than that of GMS staining(100%),while no significant difference was observed compared to serum BDG(91.4%)(P>0.05).Notably,93%of PJP patients presented with mixed infections,with the highest incidence of co-infections involving bacteria,fungi,and viruses(26 cases,33%).Conclusion mNGS demonstrates excellent sensitivity and specificity for diagnosing PJP and facilitates the rapid identification of co-pathogens in mixed infections.This capability is instrumental in the early,swift,and accurate diagnosis of PJP,thereby enhancing targeted antimicrobial therapy.

关 键 词：宏基因组二代测序 耶氏肺孢子菌肺炎 肺泡灌洗液 混合感染 诊疗价值 

分 类 号：R563.1[医药卫生—呼吸系统]