■本研究旨在探讨宏基因组下一代测序(mNGS)在肺弥漫性渗出性病变中的临床应用价值。
■从2014年1月1日至2021年11月31日,福建省立医院收治的136例胸部影像学表现为肺弥漫性渗出性病变的患者纳入研究;其中,77例患者行mNGS病原体检测。根据病原体检测结果和临床诊断,患者分为感染组(IG)和非感染组(NIG).比较了mNGS技术和传统培养方法的诊断效能。同时,59名临床鉴定为具有感染性肺弥漫性渗出性病变但未接受mNGS测试的患者被指定为非NGS感染组(非IG)。对IG和非IG患者进行了回顾性队列研究,30天全因死亡率终点用于随访。
■与常规培养方法相比,mNGS的灵敏度提高了约35%(80.0%vs45.5%,P<0.001),特异性无显著差异(77.3%vs95.5%,P=0.185)。在接触抗生素的情况下,mNGS检测的阳性率明显高于传统培养方法,表明mNGS受抗生素暴露的影响较小(P<0.05)。30天内,IG与非IG患者的全因死亡率分别为14.55%和37.29%,分别为(P<0.05)。在进行COX回归分析以调整混杂因素后,分析显示,CURB-65评分≥3分(HR=3.348,P=0.001)和存在心血管疾病(HR=2.473,P=0.026)是这些患者的独立危险因素.相反,mNGS检测(HR=0.368,P=0.017)是一个独立的保护因素。
■mNGS技术可以更轻松地查明肺部弥漫性感染性渗出性病变的原因,而不会受到抗生素的太多干扰,帮助医生尽早发现和诊断这些问题,从而在帮助他们为患者决定最佳治疗方法方面发挥关键作用。这样的结论可能有偏见,因为缺乏血清学检测和PCR等其他常规诊断技术的完整结果,传统方法的性能可能被低估。
UNASSIGNED: This
study aims to investigate the clinical application value of Metagenome Next-Generation Sequencing (mNGS) for pulmonary diffuse exudative lesions.
UNASSIGNED: From January 1, 2014, to November 31, 2021, 136 cases with chest radiologic presentations of pulmonary diffuse exudative lesions admitted to Fujian Provincial Hospital were included in the
study; of those, 77 patients underwent mNGS pathogen detection. Based on the pathogen detection outcomes and clinical diagnoses, patients were categorized into an infection group (IG) and a non-infection group (NIG). A comparison was made between the diagnostic efficacy of the mNGS technique and traditional culture methods. Meanwhile, 59 patients clinically identified as having infectious pulmonary diffuse exudative lesions but who did not receive mNGS testing were designated as the non-NGS infection group (non-IG). A retrospective cohort
study was conducted on patients in both the IG and non-IG, with a 30-day all-cause mortality endpoint used for follow-up.
UNASSIGNED: When compared to conventional culture methods, mNGS demonstrated an approximate 35% increase in sensitivity (80.0% vs 45.5%, P<0.001), without significant disparity in specificity (77.3% vs 95.5%, P=0.185). Under antibiotic exposure, the positivity rate detected by mNGS was notably higher than that by traditional culture methods, indicating that mNGS is less affected by exposure to antibiotics (P<0.05). Within 30 days, the all-cause mortality rate for patients in the IG versus the non-IG was 14.55% and 37.29%, respectively (P<0.05). Following a COX regression analysis to adjust for confounding factors, the analysis revealed that a CURB-65 score ≥3 points (HR=3.348, P=0.001) and existing cardiovascular disease (HR=2.473, P=0.026) were independent risk factors for these patients. Conversely, mNGS testing (HR=0.368, P=0.017) proved to be an independent protective factor.
UNASSIGNED: mNGS technology makes it easier to pinpoint the cause of pulmonary diffuse infectious exudative lesions without much interference from antibiotics, helping doctors spot and diagnose these issues early on, thereby playing a key role in helping them decide the best treatment approach for patients. Such conclusions may have a bias, as the performance of traditional methods might be underestimated due to the absence of complete results from other conventional diagnostic techniques like serological testing and PCR.