宏基因二代测序技术在艾滋病患者肺部感染中的临床应用

Clinical application of metagenomic next-generation sequencing in pulmonary infection for patients with AIDS

目的比较宏基因二代测序技术(metagenomic next-generation sequencing,mNGS)与传统病原学诊断方法对艾滋病患者肺部感染病原学诊断的优劣,为临床诊治提供参考依据。方法回顾北京佑安医院感染科2019年7月至2021年1月行mNGS检测的艾滋病患者其出院主诊断为肺部感染者。对mNGS送检呼吸道样本的病例进行分析,比较mNGS检测与传统临床检测结果对肺部感染诊断的敏感性、诊断效能及在不同病原体中的检测价值。结果共55例艾滋病合并肺部感染患者入组。29例送检呼吸道样本的病例中,mNGS检测对肺部感染病原诊断敏感性显著高于传统检测方法(89.7%vs.37.9%,P<0.001)。二者诊断结果一致性较差(Kappa=0.249,P=0.170),体现在mNGS在诊断细菌性感染(90.9%vs.9.1%,P<0.001)、肺孢子菌(仅mNGS检测到)及非结核分枝杆菌感染(仅mNGS检测到)中优于传统诊断方法。结论相较于传统临床诊断方法,mNGS检测对诊断艾滋病患者肺部感染具有较高敏感性,尤其在细菌、肺孢子菌及非结核分枝杆菌感染的诊断中更具优势。

Objective Comparing the diagnostic performance of pulmonary infection pathogens between metagenomic next-generation sequencing(mNGS)testing and traditional assay in patients with AIDS to provide references for the diagnosis and treatment of the disease.Methods From July 2019 to January 2021,the regular clinical assays as well as mNGS testing were performed for patients and those discharged with a diagnosis of AIDS and pulmonary infection were retrospectively reviewed in the department of infectious diseases of Beijing You An Hospital.The cases with discharge diagnosis of AIDS for whom mNGS testing was performed on samples from respiratory system were analyzed.Diagnostic performance of pathogens was compared between mNGS testing and traditional etiologyic diagnostic method.Diagnosis concordance analysis and diagnostic comparison study between mNGS and traditional etiology diagnosis method in terms of pathogens were also performed.Results Fifty-five cases discharged with AIDS and pulmonary infection were enrolled..For 29 cases for whom mNGS testing was performed on samples from respiratory system,the sensitivity of mNGS for diagnosing infection was higher than that of traditional etiology diagnosis method(89.7%vs.37.9%,P<0.001)but with poor consistency(Kappa=0.249,P=0.170).A superior positivity rate in mNGS than that in traditional etiology diagnosis method for diagnosing bacterial(90.9%vs.9.1%,P<0.001)Pneumocystis jirovecii(mNGS only),and nontuberculous mycobacteria(mNGS only).Conclusions mNGS could yield a higher sensitivity for pulmonary pathogen identification in AIDS patients,especially for bacterial,Pneumocystis jirovecii and nontuberculous mycobacteria compared to traditional etiologic diagnostic method.