mNGS在非HIV感染慢性肾脏病患者并发耶氏肺孢子菌肺炎中的诊断价值

Diagnostic Value of mNGS in non-HIV Infected Patients with Chronic Kidney Disease Complicated with Pneumocystis Jirovecii Pneumonia

目的探究宏基因组二代测序技术(mNGS)在慢性肾脏病(CKD)并发耶氏肺孢子菌肺炎(PJP)中的诊断价值。方法本研究纳入2019年9月10日至2022年8月21日天津大学天津医院肾内科收治的疑似并发PJP的非人类免疫缺陷病毒(HIV)感染的10例CKD患者,回顾性分析其临床特点及诊治过程,评价mNGS在CKD并发PJP中的诊断价值。结果该报告共包括10例拟诊PJP的CKD病例,其中7例收取的是痰标本,余下3例为肺泡灌洗液标本。经mNGS检测,10例标本中均检测到耶氏肺孢子菌,其中9例最终确诊为PJP。9例患者均有发热、咳嗽咳痰、胸闷等肺炎相关表现,实验室检查结果包括白细胞计数升高(70%)、中性粒细胞比值升高(100%)、C反应蛋白升高(100%)、淋巴细胞计数降低(100%)、HIV检测均阴性、白蛋白计数降低(100%)、肌酐值升高(100%)、G试验阳性(70%)、氧合指数≤300(70%)及乳酸脱氢酶升高(100%),肺部CT均表现为肺部感染征象,以上结果均提示继发性免疫缺陷伴感染,但推测病原菌结果不具有特异性。9例患者中有6例经治疗后病情好转,其余3例治疗无效死亡。结论mNGS可用于继发性免疫缺陷疾病并发PJP的早期病原学诊断,为临床针对耶氏肺孢子菌进行及时、有效治疗提供了有力的病原学证据,同时也突出了该基因检测技术在快速诊断病原体方面的巨大潜力。

Objective To explore the diagnostic value of metagenomic next-generation sequencing(mNGS)in chronic kidney diseases(CKD)with pneumocystis jirovecii pneumonia(PJP).Methods A total of 10 non-human immunodeficiency virus(HIV)infected patients with CKD suspected to be complicated with PJP admitted to the Department of Nephrology of Tianjin Hospital of Tianjin University from September 10,2019 to August 21,2022 were included in this study.The clinical characteristics,diagnosis and treatment process of the patients were retrospectively analyzed to evaluate the diagnostic value of mNGS in patients with CKD complicated with PJP.Results A total of 10 cases of CKD with suspected PJP were included in this report,7 of which were sputum specimens and the remaining 3 were alveolar lavage fluid specimens.By mNGS detection,pneumocystis jirovecii was detected in all the 10 samples,and 9 of them were finally diagnosed as PJP.Among the 9 cases,all patients had fever,cough and phlegm,chest tightness and other pneumonia related manifestations.Laboratory findings included increased white blood cell count(70%),increased neutrophil ratio(100%),increased C-reactive protein(100%),decreased lymphocyte count(100%),negative HIV test,decreased albumin count(100%),increased creatinine level(100%),G test positive(70%),oxygenation index≤300(70%)and elevated lactate dehydrogenase(100%),lung CT showed signs of lung infection,the above results suggested secondary immune deficiency with infection,but speculated that the pathogen results were not specific.Of the 9 patients,6 patients got better after treatment,and the remaining 3 patients died after treatment.Conclusion mNGS can be used in the early etiological diagnosis of secondary immunodeficiency diseases complicated with PJP,which provides strong etiological evidence for the timely and effective clinical treatment of pneumocystis jirovecii,and also highlights the great potential of this gene detection technology in the rapid diagnosis of pathogens.