宏基因组测序技术应用于艾滋病机会性感染诊断价值分析

Diagnostic value by metagenomics next-generation sequencing on AIDS related opportunistic infections

目的分析宏基因组二代测序技术(mNGS)应用于艾滋病机会性感染诊断的应用价值。方法采用回顾性研究方法,纳入2019年11月至2021年11月南宁市第四人民医院收治的33例艾滋病合并机会性感染病例,根据感染部位收集血液/骨髓、脑脊液、肺泡灌洗液,进行常规微生物综合试验(CMT)检查和mNGS检测,并以临床综合判定结果作为参考标准,比较mNGS和CMT在艾滋病合并机会性感染诊断效能的差异,分析mNGS对于艾滋病机会性感染感染的诊断价值。结果mNGS与CMT在真菌、病毒、弓形虫检测方面结果较为一致。细菌检测方面,mNGS检测出细菌感染并确定病原微生物共13例次,CMT鉴定出病原微生物5例次;CMT检测中有8例提示细菌感染,但培养阴性不能确定细菌种类,结合mNGS检测确定菌种。mNGS技术在艾滋病合并机会性感染患者感染性疾病的诊断敏感度高于CMT(78.0%vs.66.0%),差异有统计学意义(χ^(2)=7.265,P<0.01),两种诊断特异度差异无统计学意义(36.4%vs.31.8%,χ^(2)=2.372,P=0.193)。结论mNGS技术相较于CMT在细菌感染菌种鉴定上具有优势,有助于精准诊断及治疗。在艾滋病合并的常见真菌、病毒、原虫感染中,CMT与mNGS对于病原微生物的鉴定能力无明显差别。

Objective To analyze the value of using mNGS in the diagnosis of AIDS related opportunistic infections.Methods We conducted a retrospective study among 33 AIDS patients with opportunistic infections who were admitted to the Fourth People's Hospital of Nanning from November 2019 to November 2021.Samples from blood/bone marrow,cerebrospinal fluid,and alveolar lavage fluid were collected according to the infection sites and were tested by conventional comprehensive microbial comprehensive test(CMT)and mNGS.The comprehensive clinical evaluation results were used as the reference standard,to compare the diagnostic efficacy difference in mNGS and CMT in HIV coopportunistic infections,and to analyze the diagnostic value of mNGS in HIV co-opportunistic infections.Results The results of mNGS and CMT were consistent in the detection of fungi,viruses,and toxoplasma gondi.In terms of bacterial detection,13 cases of bacterial infection were detected by mNGS,and 5 cases were identified by CMT.8 cases with bacterial infections were positive in CMT but bacterial species could not be determined due to negative culture.However,bacterial species were determined by both CMT and mNGS tests.The diagnostic sensitivity of mNGS was significantly higher than that of CMT(78.0%vs.66.0%)in HIV patients with opportunistic infections(χ^(2)=7.265,P<0.01).There was no difference in diagnostic-specificity between two test methods(36.4%vs.31.8%,χ^(2)=2.372,P=0.193).Conclusions Compared with CMT,mNGS technology has significant advantages in the identification of bacterial infection species,such as high accuracy and genus identification,which is conducive to accurate diagnosis and treatment.There is no significant difference between CMT and mNGS in the identification of pathogenic microorganisms among the common fungal,viral,and protozoan infections associated with AIDS.