宏基因组二代测序在肺部感染性疾病病原学诊断中的价值

Value of metagenomic next-generation sequencing in the etiological diagnosis of pulmonary infectious diseases

目的探讨宏基因组二代测序(mNGS)在肺部感染性疾病病原学诊断中的价值。方法本研究为横断面回顾性研究,选取2019年6月至2021年6月滨州医学院烟台附属医院呼吸与危重症医学科收治的82例肺部感染性疾病患者,男42例,女40例,年龄(53.12±22.38)岁,年龄范围为31~75岁。检测支气管肺泡灌洗液(BALF)、血液、肺组织、胸水、痰液、咽拭子mNGS的结果,与常规病原学检测方法结果比较,分析mNGS在肺部感染性疾病病原学诊断中的价值。结果在BALF、血液、肺组织、胸水、咽拭子中,mNGS检测致病菌阳性率分别为88.4%(38/43)、69.6%(16/23)、100%(6/6)、75.0%(3/4),100%(3/3);常规病原学检测致病菌阳性率分别为25.6%(11/43)、8.7%(2/23)、33.3%(2/6)、0%(0/4)、33.3%(1/3)。两者比较,差异均有统计学意义(P<0.05)。mNGS灵敏度为81.8%,特异度为55.6%,常规病原学灵敏度29.1%,特异度为92.6%。mNGS检测结果中排在前5位的为人类疱疹病毒、结核分枝杆菌、链球菌、烟曲霉、念珠菌。结论mNGS同常规病原学检测方法相比,检测周期更短,阳性率更高,尤其在诊断特殊病原体,如结核分枝杆菌、真菌方面,首选BALF作为检测标本。mNGS诊断肺部感染性疾病较常规病原学检测方法更快速、全面、准确,可作为肺部感染性疾病病原学诊断的方法之一。

Objective To explore the value of metagenomic next-generation sequencing(mNGS)in etiological diagnosis of pulmonary infectious diseases.Methods This study was a cross-sectional retrospective study,a total of 82 patients with pulmonary infectious diseases were selected from the department of Respiratory and Critical Care,Yantai Affiliated Hospital of Binzhou Medical University from June 2019 to June 2021,including 42 males and 42 females,aged(53.12±22.38)years old,ranging from 31 to 75 years old.The results of bronchoalveolar lavage fluid(BALF),blood,lung tissue,pleural fluid,sputum and throat swab mNGS were tested,and the results of conventional pathogenic detection methods were compared to analyze the value of mNGS in the pathogenic diagnosis of pulmonary infectious disease.Results The positive rate of mNGS in Balf,blood,tissue,pleural fluid,throat swab was 88.4%(38/43)、69.6%(16/23)、100%(6/6)、75.0%(3/4),100%(3/3)were compared with that of routine pathogens 25.6%(11/43),8.7%(2/23),33.3%(2/6),0%(0/4),33.3%(1/3),the differences were statistically significant(P<0.05).The mNGS sensitivity was 81.8%,specificity 55.6%,and conventional etiology sensitivity 29.1%and specificity 92.6%.The top five of the mNGS test results were human herpesvirus,Mycobacterium tuberculosis,Streptococcus,Aspergillus,and Candida.Conclusions Compared with conventional pathogen detection methods,mNGS has a shorter detection cycle and the positive rate is higher.Especially in the diagnosis of special pathogens,such as tuberculosis and fungi,BALF is the preferred specimen;the diagnosis of pulmonary infectious diseases is more rapid,comprehensive and accurate,and can be used as one of the pathogenic diagnosis methods of pulmonary infectious diseases.