■宏基因组下一代测序(mNGS)是一种高通量测序技术,可直接从临床标本中识别多种病原体。本研究评估了mNGS在吉罗韦西肺孢子菌肺炎(PJP)中的诊断价值,并将其疗效与传统检测方法进行了比较。包括Grocott甲胺银(GMS)染色,血清(1-3)-β-D-葡聚糖(BDG)检测,和乳酸脱氢酶(LDH)测试。
■包括2022年1月至2023年3月期间住院的78例疑似肺部感染患者。如果患者表现出发烧等症状,则有资格获得mNGS,咳嗽,呼吸困难,或进行性低氧血症,符合PJP的具体临床标准。获得的标本包括支气管肺泡灌洗液,痰,和外周血。比较了mNGS和传统方法检测到的阳性率和病原体分布。
■在PJP组中,25%,37.5%,9.38%的患者有实体器官肿瘤,使用皮质类固醇,和皮肤病,分别,显著高于非PJP组。mNGS的敏感性和特异性均为100%,显著高于血清BDG(敏感性50%,特异性81.8%)和LDH(灵敏度9.3%,特异性91.3%)。观察到PJP和Non-PJP组之间微生物组成的显著差异。mNGS在96.88%的PJP病例中检测到多种混合病原体,68.75%表现出混合的细菌和病毒感染。值得注意的是,根据mNGS结果,71%的患者在抗菌治疗后有所改善。
■mNGS技术在诊断PJP方面表现出卓越的敏感性和特异性,并指导复杂肺部感染的精确治疗。
UNASSIGNED: Metagenomic next-generation sequencing (mNGS) is a high-throughput sequencing technique that identifies a wide array of pathogens directly from clinical specimens. This study evaluates the diagnostic value of mNGS in Pneumocystis jirovecii pneumonia (PJP) and compares its efficacy with traditional detection methods, including Grocott\'s Methenamine Silver (GMS) staining, serum (1-3)-β-D-Glucan (BDG) testing, and Lactate Dehydrogenase (LDH) testing.
UNASSIGNED: Seventy-eight patients hospitalized between January 2022 and March 2023 with suspected pulmonary infections were included. Patients were eligible for mNGS if they exhibited symptoms such as fever, cough, dyspnea, or progressive hypoxemia, and met specific clinical criteria for PJP. Specimens obtained included bronchoalveolar lavage fluid, sputum, and peripheral blood. Positive rates and pathogen distributions detected by mNGS and traditional methods were compared.
UNASSIGNED: In the PJP group, 25%, 37.5%, and 9.38% of patients had solid organ tumors, corticosteroid use, and skin diseases, respectively, significantly higher than in the non-PJP group. The sensitivity and specificity of mNGS were both 100%, significantly higher than those of serum BDG (sensitivity 50%, specificity 81.8%) and LDH (sensitivity 9.3%, specificity 91.3%). Significant differences in microbial composition between the PJP and Non-PJP groups were observed. mNGS detected multiple mixed pathogens in 96.88% of PJP cases, with 68.75% exhibiting mixed bacterial and viral infections. Notably, 71% of patients improved following antibacterial treatment based on mNGS results.
UNASSIGNED: mNGS technology shows superior sensitivity and specificity in diagnosing PJP and guides precise treatment for complex pulmonary infections.