应用宏基因组二代测序诊断的13例肺诺卡菌病患者的临床特征分析

Clinical characteristics of 13 patients with pulmonary nocardiosis diagnosed by metagenomic Next-Generation Sequencing

目的回顾性分析肺诺卡菌病患者的临床资料,以提高对该病的认识,并探讨病原宏基因组二代测序(metagenomic Next-Generation Sequencing,mNGS)在诺卡菌病诊断的应用价值。方法收集2019年1月~2021年8月厦门大学附属第一医院mNGS确诊为肺诺卡菌病的13例患者的临床资料,分析其临床特征并追踪其治疗与转归。结果(1)13例患者中,男性5例,女性8例,年龄37~78岁,平均年龄(58±12)岁,体重指数(BMI)为(19.63±3.43)kg/m^(2),3例有长期吸烟史。(2)13例患者中只有1例无基础疾病,余12例均存在基础疾病,主要合并慢性呼吸系统疾病以及自身免疫性疾病,其中6例患者在进行糖皮质激素或者免疫抑制剂的治疗。(3)患者的主要临床症状包括发热、咳嗽咳痰、呼吸困难等。(4)在所有经mNGS检出的诺卡菌患者中,诺卡菌分型主要为亚洲诺卡菌。(5)9例患者表现为双肺受累,主要表现为斑片或结节状高密度影。(6)所有患者都接受了磺胺甲噁唑治疗,大部分患者在此基础上联合其他药物治疗。结论肺诺卡菌病多见于慢性呼吸系统疾病以及自身免疫性疾病的患者,对于这类患者,在考虑肺部感染进行常规治疗效果不佳时,应考虑到诺卡菌感染以及运用mNGS进行病原学的检测,及早的进行针对性治疗。

Objective The clinical data of 13 cases were reviewed to improve the understanding of pulmonary nocardiosis and investigate the application of metagenomic Next-Generation Sequencing(mNGS) in the diagnosis of nocardiosis.Methods A retrospective study was conducted to analyze the clinical data of 13 patients with pulmonary nocardiosis diagnosed by mNGS in the First Affiliated Hospital of Xiamen University from January 2019 to August 2021.Results Among the 13 patients,there were 5 males and 8 females,aged 37~78 years old,with an average age of(58±12) years old,and their average body mass index(BMI) were(19.63±3.43) kg/m^(2).And 3 of them had a long history of smoking exposure.(2) All but one had underlying diseases,mainly chronic respiratory diseases and autoimmune diseases,and 6 of them had received glucocorticoids or immunosuppressive treatments.(3) The common clinical manifestations were fever,cough,expectoration and dyspnea.(4) Among 13 patients with pulmonary nocardiosis diagnosed by mNGS,the main strains were Nocardia asiatica.(5) The main findings on lung CT images were patchy and nodular shadows and bilateral lung involvement was present in 9 cases.(6) All patients were treated with compound sulfamethoxazole tablets and most patients also received other drugs on this basis.Conclusions Chronic respiratory diseases and immunocompromised status make individuals vulnerable to pulmonary nocardiosis.And it should be highly suspected in these patients when they are unresponsive to conventional treatment.What's more,the early identification of pathogens by mNGS will enable timely initiation of targeted therapies.