靶向宏基因组测序技术在不明原因肺部感染病原学诊断中的价值

Targeted metagenomic sequencing in the diagnosis of pulmonary infection of unknown etiology

目的探讨靶向宏基因组测序(tNGS)技术在不明原因肺部感染病原学诊断中的价值。方法选取2023年3月-11月114例于本院就诊的不明原因肺部感染患者为研究对象。采集患者支气管肺泡灌洗液或痰液标本,分别进行tNGS测序及传统的病原学检测。依据临床病原学诊断将病例分为细菌感染、真菌感染、病毒感染及结核分枝杆菌感染4类,采用SPSS软件比较tNGS与传统方法检出率的差异。结果114例患者传统病原学检测及tNGS检测的阳性率分别为32.5%(37/114)、89.5%(102/114),差异具有统计学意义(P<0.05)。传统病原学检测方法检出细菌、真菌、病毒和分枝杆菌的阳性率分别为:26.32%、7.02%、0%和0%。tNGS检测方法检出阳性率分别为:83.33%、23.68%、22.81%和11.40%。对于各类病原体,tNGS检测阳性率均高于传统方法(P<0.05)。传统病原学检测方法检出单一感染、二重混合感染和三重及以上混合感染分别为:31例(83.78%),6例(16.22%)和0例(0.00%);tNGS检测方法检出分别为:24例(23.53%),31例(30.39%)和47例(46.08%)。在混合感染检测中,tNGS对于二重混合感染和三重及以上混合感染的检出率高于传统方法。tNGS检测与传统病原学检测方法对检出病原体对比,9例完全一致,17例部分一致,11例不一致。结论与传统的病原学检测相比,tNGS在肺部感染的病原学诊断中具有更高的阳性率和检测效率,尤其适用于传统方法检测阴性但临床怀疑存在感染的情况,为传统诊断提供有力的补充,全面提升病原体的检出效率。

Objective To investigate the value of targeted metagenomic sequencing(tNGS)in the etiological diagnosis of pulmonary infection of unknown etiology.Methods A total of 114 patients with unexplained pulmonary infection who visited our hospital from March to November 2023 were selected as the research subjects.Bronchoalveolar lavage fluid or sputum specimens of the patients were collected for tNGS sequencing and traditional etiological detection.According to the clinical etiological diagnosis,the cases were divided into four categories:bacterial infection,fungal infection,viral infection and mycobacterium tuberculosis infection.The SPSS software was used to compare the difference in the detection rates between tNGS and traditional etiological detection.ResultsThe positive rates of traditional etiological detection and tNGS detection in 114 patients were 32.5%(37/114)and 89.5%(102/114),respectively,and the difference was statistically significant(P<0.05).The positive rates of bacteria,fungi,viruses and mycobacteria detected by traditional etiological detection methods were:26.32%,7.02%,0% and 0% respectively.The positive rates detected by the tNGS detection method were:83.33%,23.68%,22.81%and 11.40% respectively.For various pathogens,the positive rate of tNGS detection was higher than that of traditional methods(P<O.05).The traditional etiological detection method detected single infection,double mixed infection and triple or more mixed infection as follows:31 cases(83.78%),6 cases(16.22%)and 0 cases(0.00%);the tNGS detection method detected them as follows:24 cases(23.53%),31 cases(30.39%)and 47 cases(46.08%)respectively.In the detection of mixed infection,tNGS had a higher detection rate of double and triple or more mixed infections than traditional methods.In the comparison of pathogen detection between the tNGS detection and traditional etiological detection methods,9 cases were completely consistent,17 cases were partially consistent,and 11 cases were inconsistent.Conclusion Compared with traditional etiological detection,tNGS had higher positive rate and detection efficiency in the etiological diagnosis of pulmonary infection,especially suitable for cases where traditional methods were negative but clinical suspicion of infection existed.It provided a powerful complement to traditional diagnosis and comprehensively improved the detection efficiency of pathogens.