20例耶氏肺孢子菌肺炎的临床特点及宏基因组二代测序在其诊断中的价值

Clinical characteristics of 20 cases of PJP and the value of NGS in the diagnosis of PJP

目的分析PJP的临床特征及高危因素,并探讨NGS在PJP诊断中的价值,以及PJP患者可能的预后指标。方法收集2020年4月—2021年12月我科收治的20例PJP患者的临床资料,分析临床特点,比较治疗前后实验室指标差异及不同检测方法在诊断中的价值。结果20例患者肺泡灌洗液NGS均提示肺孢子菌感染,血G试验阳性率90%,病原学涂片及培养阳性率为0。经抗PJP治疗后14例患者获得临床缓解,治疗前后外周血淋巴细胞计数差异具有统计学意义。结论mNGS在PJP诊断中有较高参考价值,灵敏度明显高于常规病原学涂片及培养。相比G试验,NGS不仅可以识别感染病原菌并且灵敏度极高,具有明显优势。此外,外周血淋巴细胞与疾病的恢复正相关,可作为PJP患者预后的实验室标志之一。

Objective To analyze the clinical features and high-risk factors of Pneumocystis jirovecii pneumonia(PJP),explore the value of metagenomic sequencing(mNGS)in the diagnosis of PJP,and seek possible prognostic indicators in PJP patients.Methods From April 2020 to DecembeR2021,the clinical data of 20 PJP patients admitted to ouRdepartment were collected,and theiRclinical characteristics were analyzed.The differences in laboratory indexes before and afteRtreatment and the value of different detection methods in diagnosis were compared.Results Pneumocystis infection was detected by NGS in BALF of 20 patients,meanwhile,the positive rate of blood G test was 90%.However,neitheRsmears noRcultures of the pathogen showed signs of pneumocystis infection.AfteRanti-PJP treatment,14 cases were clinically relieved,and the difference in peripheral blood lymphocyte.Conclusion Compared with the sensitivity of conventional etiological smears and cultures,mNGS showed betteRvalue in the diagnosis of PJP.NGS could identify pathogens with high sensitivity.In addition,peripheral blood lymphocytes were positively correlated with disease recovery and could be used as one of the laboratory markers of prognosis in PJP patients.