病原二代测序在免疫抑制宿主肺炎患者肺泡灌洗液病原学诊断中的研究  

Study of pathogenic next generation sequencing in the etiological diagnosis of alveolar lavage fluid in patients with immunosuppressive host pneumonia

作　　者：马佳琪 贾林杰 柏佳 余慕清 赵建平[1] 徐永健[1] 周敏[1] Ma Jiaqi;Jia Linjie;Bai Jia;Yu Muqing;Zhao Jianping;Xu Yongjian;Zhou Min(Department of Respiratory Diseases and Critical Care Medicine,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院呼吸与危重症医学科,武汉430030 [2]重庆市渝中区大坪医院心血管内科

出　　处：《临床内科杂志》2025年第3期204-208,共5页Journal of Clinical Internal Medicine

基　　金：国家自然科学基金青年项目(81700032)。

摘　　要：目的 探讨不同类型二代测序(NGS)技术在免疫抑制宿主肺炎(ICHP)患者肺泡灌洗液病原学诊断中的价值。方法 将58例ICHP患者分为重度ICHP组(34例)和轻度ICHP组(24例)。比较两组患者的临床资料、常规病原和NGS病原学检测结果及预后情况。结果 临床特征方面,重度ICHP组实体器官恶性肿瘤患者比例及超敏C反应蛋白(hs-CRP)水平均显著高于轻度ICHP组,风湿免疫相关疾病患者比例及淋巴细胞计数均低于轻度ICHP组(P<0.010)。病原学方面,所有患者检出病原体均以混合感染为主(82.8%)。重症肺炎患者感染病原体主要为铜绿假单胞菌(30.4%)、流感嗜血杆菌(17.4%)及耶氏肺孢子菌(21.7%)。靶向NGS(tNGS)及宏基因组NGS(mNGS)检测阳性率均显著高于临床常规病原体检测(CMTs,P<0.05)。tNGS对铜绿假单胞菌、EB病毒、巨细胞病毒的检出率均显著高于mNGS(P<0.05)。结论 病原学NGS技术是ICHP患者临床常规病原学诊断的重要补充手段,tNGS在ICHP患者的支气管肺泡灌洗液病原学检测中的诊断效能与mNGS相当。Objective To investigate the value of different types of next generation sequencing(NGS)techniques in the etiological diagnosis of alveolar lavage fluid in patients with immunosuppressed host pneumonia(ICHP).Methods A total of 58 patients with ICHP were divided into severe ICHP group(34 cases)and mild ICHP group(24 cases).The clinical data,conventional pathogens,NGS etiological results and prognosis of the two groups were compared.Results In terms of clinical features,the proportion of patients with malignant tumors in solid organs and the level of hypersensitive C-reactive protein(hs-CRP)in severe ICHP group were significantly higher than those in mild ICHP group,and the proportion of patients with rheumatism and immune-related diseases and lymphocyte count were lower than those in mild ICHP group(P<0.010).In terms of etiology,mixed infection was the main pathogen detected in all patients(82.8%).The main pathogens of severe pneumonia were pseudomonas aeruginosa(30.4%),haemophilus influenzae(17.4%)and pneumocystis yersoni(21.7%).The positive rates of targeted NGS(tNGS)and metagenomics NGS(mNGS)were significantly higher than those of conventional microbiological tests(CMTs,P<0.05).The detection rate of tNGS against Pseudomonas aeruginosa,EB virus and cytomegalovirus was significantly higher than that of mNGS(P<0.05).Conclusion Etiological NGS technique is an important supplement to the routine etiological diagnosis of ICHP patients.The efficacy of tNGS in the etiological diagnosis of bronchoalveolar lavage fluid in ICHP patients is comparable to that of mNGS.

关 键 词：社区获得性肺炎 免疫抑制宿主肺炎 靶向二代测序 宏基因组二代测序 支气管肺泡灌洗液 

分 类 号：R563.1[医药卫生—呼吸系统]