| 姜寒水,鲁尔旦,陆明,吴国明,祝艳,刘晴晴,李宗煜.宏基因组测序在实体器官移植术后肺部感染患者中应用价值初探[J].浙江中西医结合杂志,2023,33(6): |
| 宏基因组测序在实体器官移植术后肺部感染患者中应用价值初探 |
| Application value of metagenomic sequencing in patients with pulmonary infection after solid organ transplantation |
| 投稿时间：2022-07-07 修订日期：2022-11-14 |
| DOI： |
| 中文关键词: 宏基因组测序 实体器官移植 肺部感染 支气管肺泡灌洗液 病原学检测 |
| 英文关键词:mNGS Solid organ transplantation Pulmonary infections Bronchoalveolar lavage fluid Etiological detection |
| 基金项目: |
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| 摘要点击次数: 492 |
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| 中文摘要: |
| 目的 通过比较实体器官移植术后肺部感染患者支气管肺泡灌洗液的病原学检测方法，探索宏基因测序技术的应用价值。
方法 57例诊断为肺部感染的肝移植和肾移植受者均采集支气管肺泡灌洗液，对标本仅采用传统病原学检测方法的有38例，为传统方法组。接受mNGS和传统病原学检测方法的有19例，为mNGS组。传统方法组进行细菌、真菌、抗酸杆菌涂片及培养，呼吸道多项病原体抗原抗体、Gene Xpert MTB/RIF检测等传统病原学检测方法。mNGS组除行常规传统检测方法外，标本同时送检宏基因组测序。比较两组病原学检出情况、确诊时间、采信率和住院时间等。采用SPSS 21.0对数据进行统计分析。
结果 mNGS组病原学检出阳性率94.74%（18/19），传统方法组病原学阳性率47.36%（18/38），两组差异有统计学意义（χ2=13.36，P <0.01）。病原学阳性的36例病例中，传统方法组和mNGS组的中位确诊时间分别为3.0（2.0,4.8）天和1.0(1.0,1.25)天，差异具有统计学意义（Z=4.746, P <0.01）。mNGS结果被采信的有94.4%（17/18）,传统方法组仅72.2%（13/18）,两组病原学结果临床采信率（F=3.446, P =0.063）,无显著统计学差异。mNGS组和传统方法组的中位住院天数分别为24.0（13.0,40.0）天和21(12.0,30.0) 天，两组住院天数分布差异无统计学意义（Z=0.373，P=0.709）。
结论 实体器官移植后肺部感染患者支气管肺泡灌洗液mNGS检测阳性率显著高于传统检测方法，且缩短确诊时间，尤其在耶氏肺孢子菌、巨细胞病毒、军团菌等特殊病原体检测中有较大优势。 |
| 英文摘要: |
| Objective To explore the application value of metagenomic sequencing technology, the etiological detection methods of bronchoalveolar lavage fluid in patients with pulmonary infection after solid organ transplantation were compared.
Methods Bronchoalveolar lavage fluid was collected from 57 liver and kidney transplant recipients who were diagnosed with pulmonary infection, and 38 of them were enrolled in the traditional method group. There were 19 patients in the mNGS group who received mNGS and traditional etiological detection methods. In the traditional method group, smear and culture of bacteria, fungi and acid-fast bacilli were performed, as well as the detection of multiple respiratory pathogens antigens and antibodies, Gene Xpert MTB/RIF and other traditional pathogen detection methods. In the mNGS group, in addition to conventional detection methods, BALF were also sent for metagenomic sequencing. The pathogen detection, diagnosis time, acceptance rate and hospital stay were compared between the two groups. SPSS 21.0 was used for statistical analysis of the data.
Results The positive rate was 94.74% (18/19) in the mNGS group and 47.36% (18/38) in the traditional method group, and the difference was statistically significant (χ2=13.36, P <0.01). Among the 36 cases with positive etiology, the median time to diagnosis was 3.0 (2.0,4.8) days in the traditional method group and 1.0(1.0,1.25) days in the mNGS group, with statistically significant differences (Z=4.746, P <0.01). 94.4% (17/18) of the mNGS results were confirmed, while only 72.2% (13/18) of the traditional method group. There was no significant statistical difference in the clinical acceptance rate of the two groups (F=3.446, P =0.063). The median length of stay was 24.0 (13.0,40.0) days in the mNGS group and 21(12.0,30.0) days in the traditional method group, respectively. There was no significant difference in the length of stay distribution between the two groups (Z=0.373, P=0.709).
Conclution The positive rate of mNGS detection in bronchoalveolar lavage fluid of patients with pulmonary infection after solid organ transplantation was significantly higher than that of traditional detection methods, and the diagnosis time was shortened, especially in the detection of special pathogens such as Pneumocystis jiroi, cytomegalovirus and Legionella. |
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