外周血宏基因组二代测序在肺炎中的应用价值

The application value of peripheral blood metagenomic next-generation sequencing in patients with pneumonia

目的评估外周血宏基因组二代测序(mNGS)技术在肺炎患者中微生物检测方面的应用价值。方法使用回顾性分析的方法,收集常州市第二人民医院收治的28例使用外周血mNGS技术进行病原学检测的肺炎患者,并与常规微生物学检测(CMT)方法进行比较。结果在这28例患者中,重症肺炎有19例,非重症肺炎有9例。mNGS对微生物的检出率(78.6%,22/28)与CMT(64.3%,18/28)相比差异无统计学意义(P=0.338)。mNGS对病毒的检出率高于CMT(P=0.004),但是在检出细菌(P=0.625)和真菌(P=0.118)方面无明显优势。进一步在重症肺炎患者的亚组分析中得到了同样的结果。经过综合评估,7例患者通过mNGS确诊病原体,分别为耶氏肺孢子菌(PJ)2例,PJ合并巨细胞病毒(CMV)2例,鹦鹉热衣原体2例和腺病毒1例。结论尽管血mNGS对病原微生物的检出率并不优于CMT,但是当病毒、PJ或鹦鹉热衣原体感染时,可以考虑使用血mNGS进行病原学诊断。

Objective To evaluate the application value of peripheral blood metagenomic next-generation sequencing(mNGS)technology in microbial detection in patients with pneumonia.Methods A total of 28 patients with pneumonia admitted to Changzhou Second People's Hospital who used peripheral blood mNGS technology for etiological detection were collected and compared with conventional microbiology detection(CMT)by retrospective analysis.Results Of the 28 patients,19 were severe pneumonia and 9 were non-severe pneumonia.There was no significant difference in the detection rate of microorganisms between mNGS(78.6%,22/28)and CMT(64.3%,18/28)(P=0.338).mNGS has a higher detection rate than CMT for viruses(P=0.004)but has no significant advantage in detecting bacteria(P=0.625)and fungi(P=0.118).The same results were further obtained in subgroup analyses of patients with severe pneumonia.After a comprehensive evaluation,the pathogen of 7 patients was identified by mNGS,including 2 cases of Pneumocystis jirovecii(PJ),2 cases of PJ combined with cytomegalovirus(CMV),2 cases of Chlamydia psittaci,and 1 case of adenovirus.Conclusion Compared with CMT,blood mNGS has no advantage in the etiological diagnosis of pneumonia,but when clinically suspected virus,PJ or Chlamydia psittaci infection,blood mNGS can be considered for etiological diagnosis.