宏基因组二代测序在中性粒细胞缺乏伴发热的肿瘤患者中的临床应用与价值

Clinical Application and Value of Metagenomic Next Generation Sequencing in Patients with Febrile Granulosa

目的:探讨宏基因组二代测序(mNGS)在中性粒细胞缺乏(粒缺)伴发热患者中的病原学诊断及临床应用价值。方法:对1例肿瘤患者放化疗后出现粒缺伴发热症状的治疗过程进行分析。结果:患者因肺癌多发转移经注射用奥沙利铂+依托泊苷注射液联合放疗后出现粒缺伴发热症状。因感染部位不明确,医生经验性使用注射用亚胺培南西司他丁钠+注射用替加环素+注射用醋酸卡泊芬净抗感染治疗后感染指标水平未见明显下降。48h后的mNGS结果显示,患者存在革兰阴性杆菌和巨细胞病毒感染。临床药师根据测序结果,建议在抗感染治疗的基础上加用更昔洛韦抗病毒治疗。调整药物后患者的C反应蛋白和降钙素原明显下降,随后患者的病情逐渐稳定,好转出院。结论:本研究结果提示,mNGS能够识别病毒,可以较快分析结果,且其病原学诊断优于实验室培养,可以更好地把握临床用药时机,能够帮助医生和临床药师及时选择正确的抗感染治疗方案,改善患者的预后。

Objective:To investigate the etiological diagnosis and clinical application value of metagenomic next-generation sequencing(mNGS)in patients with neutropenia(granulocytosis)and fever.Methods:The treatment process of a tumor patient with granulosa and fever after chemotherapy and radiotherapy was analyzed.Results:The patient developed granulopathy with fever after oxaliplatin and etoposide injection combined with radiotherapy due to multiple metastases of lung cancer.Because the site of infection is not clear,the infection index did not decrease significantly after empiric treatment with imipenem and cilastatin sodium for injection+tigecycline for injection+caspofungin acetate for injection.After 48h,the results of mNGS showed the patient had gram-negative bacilli and cytomegalovirus infections.According to the sequencing results,clinical pharmacists suggested to add ganciclovir antiviral therapy on the basis of antiinfective therapy.After adjusting the drug,the patient’s C reactive protein and procalcitonin decreased significantly,and then the patient's condition gradually stabilized and improved and was discharged from the hospital.Conclusion:Results show that the second-generation metagenomic sequencing can identify viruses and analyze the results faster.Its etiological diagnosis is better than laboratory culture,and can better grasp the timing of clinical medication,help doctors and clinical pharmacists timely choose the right anti-infection treatment plan,and improve the prognosis of patients.