宏基因组二代测序在社区获得性肺炎中的应用价值

Value of Metagenomic Next-generation Sequencing in Detection of Pathogens in Adults with Community-acquired Pneumonia

目的探讨宏基因组二代测序(metagenomic next-generation sequencing,mNGS)检测支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)中病原微生物在社区获得性肺炎中的诊断价值。方法选取2018年11月~2021年7月至苏州市立医院住院的初始治疗失败的社区获得性肺炎患者57例,所得BALF同时进行传统方法和mNGS检测,比较两种方法的诊断价值。结果在57例患者BALF病原学检测中,mNGS的检出率高于传统方法(80.70%vs 33.33%),差异有统计学意义(P<0.05)。mNGS检测的采信率为84.78%,敏感度为90.70%,特异性为50.00%,阳性预测值为84.78%,阴性预测值为63.64%。mNGS检测细菌阳性率高于传统方法(43.86%vs 15.79%),差异有统计学意义(P<0.05),但两者检测真菌、结核及病毒的阳性率比较,差异无统计学意义(P>0.05)。mNGS联合传统方法检测后,75.44%(43/57)患者确诊,43.86%(25/57)患者根据mNGS检测结果调整了治疗方案。结论在初治失败的社区获得性肺炎BALF病原学检测中,mNGS的检出率高于传统方法,尤其是对于细菌感染的诊断价值更高,可早期识别病原体,有效指导诊治。

Objective To explore the diagnostic value of metagenomic next-generation sequencing in detection of pathogens of BALF in patients with community-acquired pneumonia.Methods We retrospectively analyzed the clinical data of 57 patients with community-acquired pneumonia after intial treatmen failure in Suzhou Municipal Hospital from November 2018 to July 2021,and the BALFs obtained were tested by both traditional methods and mNGS to compare the diagnostic efficacy of the two methods.Results The detection rate of pathogen in the BALFs of all 57 patients by mNGS was significantly higher than that by the traditional detection methods(80.70%vs 33.33%)(P<0.05).In community-acquired pneumonia,the acceptance rate,the sensitivity,specificity,positive predictive value,and negative predictive value of mNGS for pathogenic diagnosis were 84.78%,90.70%,50.00%,84.78%and 63.64%respectively.The detection rate of bacteria in the BALFs by mNGS was higher than that by the traditional detection methods(43.86%vs 15.79%),and the difference was statistically significant(P<0.05),but there was no difference in the rate of fungal,tuberculosis and viral positivity between the two methods(P>0.05).The combination of mNGS with traditional methods resulted in a definitive pathogenic diagnosis in 75.44%of patients.43.86%of patients with a definitive diagnosis by mNGS had their treatment regimen adjusted.Conclusion In the pathogenic detection of BALFs of patients with community-acquired pneumonia after intial treatmen failure,the positive rate of mNGS is higher than that of traditional methods,especially for bacterial infection,which can identify the pathogen early and effectively guide the diagnosis and treatment.