宏基因组二代测序在免疫抑制患者肺部浸润病因诊断中的应用

Clinical application of metagenomic next-generation sequencing in the etiological diagnosis of lung infiltration in immunosuppressed patients

目的 研究宏基因组二代测序(metagenomic Next-Generation Sequencing, mNGS)在出现肺部浸润的免疫抑制患者病因诊断中的应用价值。方法 前瞻性收集2019年11月至2022年11月间收治的60例出现肺部浸润的免疫抑制患者的临床资料,采集样本(包括肺泡灌洗液、血液、深部痰液、肺组织、胸水)进行mNGS和常规实验室检查(培养、涂片等),探究mNGS在该类患者病因诊断中的性能。结果 mNGS检测的总体阳性率为88.3%,显著高于常规实验室检测方法;55.0%(33/60)患者样本的两种检测结果一致,同时mNGS对真菌、病毒和非典型病原微生物的检测优于常规检测;免疫抑制患者肺部浸润的最主要病因是感染,mNGS在病因分析中的检测灵敏度为97.7%,特异度为52.9%,阳性预测值为84.0%,阴性预测值为90.0%。结论 mNGS具有较高的灵敏度、阳性预测值和阴性预测值,可联合多种常规实验室检测方法为临床精准诊断免疫抑制患者肺部浸润的病因提供依据。

Objective To investigate the value of metagenomic next-generation sequencing(mNGS)in the etiological diagnosis of immunosuppressed patients with pulmonary infiltrates.Methods 60 immunosuppressed patients with pulmonary infiltrates admitted to the Department of Respiratory and Critical Care Medicine of Xuhui District Central Hospital in Shanghai from November 2019 to November 2022 were prospectively collected,and their samples(including bronchoalveolar lavage fluid,blood,deep sputum,lung tissue,pleural fluid)were collected for mNGS and routine laboratory tests(culture,smear,etc.)to investigate the performance of mNGS in the etiological diagnosis of those patients.Results The overall positive rate of the mNGS test was 88.3%,which was significantly higher than routine laboratory tests.55.0%of the patient samples(33/60)had consistent results for both tests,while the detection of fungi,viruses and atypical pathogenic microorganisms was better than conventional tests.The most important cause of pulmonary infiltration in patients was infection.mNGS had a sensitivity of 97.7%,a specificity of 52.9%,a positive predictive value of 84.0%and a negative predictive value of 90.0%in the etiological analysis.Conclusion mNGS has high sensitivity,positive predictive value and negative predictive value,and it can be combined with various conventional laboratory tests to provide a basis for accurate clinical diagnosis of the etiology of pulmonary infiltrates in immunosuppressed patients.