宏基因组二代测序技术在单纯疱疹肺炎混合感染患者中的应用

Application of metagenomic next-generation sequencing in patients with Herpes simplex pneumonia mixed infection

目的探讨宏基因组二代测序(mNGS)技术在单纯疱疹肺炎混合感染患者中的应用价值。方法回顾性分析扬州大学附属医院2018年6月至2021年1月行肺泡灌洗液传统病原检测和mNGS检测的肺炎患者的临床资料,包括患者一般资料、mNGS检测结果、细菌培养结果等信息,评价mNGS技术对单纯疱疹肺炎混合感染诊疗的价值。结果共纳入41例mNGS检测为单纯疱疹病毒-1型(HSV-1)阳性的患者,包括4例HSV-1病原携带者和37例HSV-1感染者(12例为HSV-1单一感染,25例为HSV-1混合感染)。男22例,女19例,年龄范围46~83岁,中位年龄67岁。采用mNGS技术检测的25例HSV-1混合感染患者占比较高的病原体分别为耶氏肺孢子虫(6例,24.0%)、鲍曼不动杆菌(4例,16.0%)、肺炎克雷伯菌(4例,16.0%)、烟曲霉(3例,12.0%)。HSV-1病原携带组、HSV-1单一感染组和HSV-1混合感染组辛普森菌群多样性指数比较,差异具有统计学意义(P<0.05)。与12例HSV-1单一感染者比较,25例HSV-1混合感染者的体温恢复正常时间更长[(5.16±2.04)d vs(3.75±1.29)d],抗感染药疗程也更长[(10.60±2.18)d vs(8.92±1.98)d],差异均有统计学意义(均P<0.05)。结论mNGS技术在识别HSV-1混合感染优势明显,有利于医师精准治疗。

Objective To explore the application value of next-generation sequencing(mNGS)technology in patients with Herpes simplex pneumonia mixed infection.Methods The clinical data of pneumonia patients who underwent alveolar lavage fluid mNGS technology and traditional pathogen detection in the Affiliated Hospital of Yangzhou University from June 2018 to January 2021 were retrospectively collected.Results A total of 41 patients with mNGS Herpes simplex type 1(HSV-1)test(4 HSV-1 carriers,37 HSV-1 infections)were enrolled in this study,including 22 males and 19 females.The age ranged from 46 to 83 years old,with a median age of 67 years.The higher proportion of pathogens in 25 cases of HSV-1 co-infection detected by mNGS were Pneumocystis jiroveci(6 cases,24.0%),Acinetobacter baumannii(4 cases,16.0%),and Klebsiella pneumoniae(4 cases,16.0%),and Aspergillus fumigatus(3 cases,12.0%).The difference in the Simpson's diversity index in the HSV-1carrier group,HSV-1 single infection group and HSV-1 mixed infection group was statistically significant(P<0.05).Compared with 12 cases of HSV-1 single infection,the time for body temperature to return to normal for 25 cases of HSV-1 mixed infection was[(5.16±2.04)days vs(3.75±1.29)days],and course of antibiotic treatment was longer[(10.60±2.18)d vs(8.92±1.98)d].Conclusions The mNGS technology has obvious advantages in identifying HSV-1 mixed infections,which is beneficial to physicians to treat them accurately.