mNGS辅助诊断耶氏肺孢子菌肺炎在17例肺癌患者中的临床价值评估
Evaluation of the Clinical Value of mNGS in the Auxiliary Diagnosis of Pneumocystis jirovecii Pneumonia in 17 Patients with Lung Cancer
DOI: 10.12677/ACM.2023.13102255, PDF,   
作者: 陈璐瑶：青岛大学医学部，山东 青岛；曲斌斌, 许亚慧, 张春玲*：青岛大学附属青岛市中心医院呼吸与危重症医学科，山东 青岛
关键词: 宏基因组二代测序；耶氏肺孢子菌肺炎；肺癌；免疫功能受损；Metagenomic Next-Generation Sequencing (mNGS)； Pneumocystis jirovecii (P. jirovecii) Pneumonia； Lung Cancer； Impaired Immune Function
摘要: 目的：本研究旨在比较肺泡灌洗联合宏基因组二代测序(mNGS)与传统的病原检测方法在诊断肺癌合并耶氏肺孢子菌肺炎(PJP)方面的价值。方法：我们纳入了青岛大学附属青岛市中心医院2020年12月至2022年8月期间住院的17例肺癌患者的临床数据，这些患者通过mNGS辅助并经临床复合诊断为PJP。我们分析了这些患者的临床特征，并评估了mNGS在肺癌患者中诊断PJP的价值。结果：与1-3-β-D-葡聚糖测定和传统的病原菌涂片培养相比，mNGS对于耶氏肺孢子菌(Pj)的检出率明显更高。这表明mNGS可以作为辅助诊断肺癌患者PJP的工具。Pj序列数与CRP呈正相关(rs = 0.537, P = 0.026)。结论：肺泡灌洗联合mNGS在诊断肺癌患者PJP方面具有一定优势。相比传统的检测方法，mNGS更快速、检出率更高，并且在识别Pj共感染方面表现出明显的优越性。因此，mNGS在临床治疗上具有更大的指导作用，并可为患者预后带来一定的收益。
Abstract: Objective: This study aims to compare the value of bronchoalveolar lavage combined with meta-genomic next-generation sequencing (mNGS) and traditional pathogen detection methods in diag-nosing lung cancer complicated with Pneumocystis jirovecii pneumonia (PJP). Methods: We includ-ed clinical data from 17 hospitalized lung cancer patients at the Affiliated Qingdao Central Hospital of Qingdao University from December 2020 to August 2022. These patients were diagnosed with PJP through mNGS assistance and clinical composite diagnosis. We analyzed the clinical characteris-tics of these patients and evaluated the value of mNGS in diagnosing PJP in lung cancer patients. Results: Compared with 1-3-β-d-glucan assay and traditional pathogenic microorganism smear cul-ture, mNGS showed a significantly higher detection rate for Pneumocystis jirovecii (Pj). This indi-cates that mNGS can be used as an auxiliary tool for diagnosing PJP in lung cancer patients. The number of Pj sequences was positively correlated with CRP levels (rs = 0.537, P = 0.026). Conclusion: Bronchoalveolar lavage combined with mNGS has certain advantages in diagnosing PJP in lung can-cer patients. Compared to traditional detection methods, mNGS is faster, has a higher detection rate, and demonstrates significant superiority in identifying co-infections by Pj. Therefore, mNGS plays a greater guiding role in clinical treatment and can bring certain benefits to patient prognosis.
文章引用：陈璐瑶, 曲斌斌, 许亚慧, 张春玲. mNGS辅助诊断耶氏肺孢子菌肺炎在17例肺癌患者中的临床价值评估[J]. 临床医学进展, 2023, 13(10): 16135-16141. https://doi.org/10.12677/ACM.2023.13102255

参考文献

[1] Varas Vicente, P., Parra Fariñas, R., Alonso-Sardón, M., Benéitez Andrés, E., Rodriguez Alonso, B., Romero-Alegría, Á., et al. (2023) Impact of Pneumocystosis on the Spanish Health Care System, 1997-2020: Profile of HIV and non-HIV Immunocompromised Patients. Journal of Infection and Public Health, 16, 831-840. [Google Scholar] [CrossRef] [PubMed]
[2] Rego de Figueiredo, I., Vieira Alves, R., Drummond Borges, D., Torres, M., Lourenço, F., Antunes, A.M., et al. (2019) Pneumocystosis Pneumonia: A Comparison Study between HIV and Non-HIV Immunocompromised Patients. Pulmonology, 25, 271-274. [Google Scholar] [CrossRef] [PubMed]
[3] Kolbrink, B., Scheikholeslami-Sabzewari, J., Borzikowsky, C., von Samson-Himmelstjerna, F.A., Ullmann, A.J., Kunzendorf, U., et al. (2022) Evolving Epidemiology of Pneumocystis Pneumonia: Findings from a Longitudinal Population-Based Study and a Retrospective Multi-Center Study in Germany. The Lancet Regional Health—Europe, 18, 100400. [Google Scholar] [CrossRef] [PubMed]
[4] Oliver, A.L. (2022) Lung Cancer: Epidemiology and Screening. Surgical Clinics of North America, 102, 335-344. [Google Scholar] [CrossRef] [PubMed]
[5] Jones, G.S. and Baldwin, D.R. (2018) Recent Advances in the Management of Lung Cancer. Journal of Clinical Medicine (Lond), 18, s41-s46. [Google Scholar] [CrossRef] [PubMed]
[6] Abdel-Rahman, O. (2021) Influenza and Pneumonia-Attributed Deaths Among Cancer Patients in the United States; a Population-Based Study. Expert Review of Respiratory Medicine, 15, 393-401. [Google Scholar] [CrossRef] [PubMed]
[7] Zhang, F., Chen, J., Huang, H., Deng, X., Zhang, W., Zeng, M., et al. (2021) Application of Metagenomic Next-Generation Sequencing in the Diagnosis and Treatment Guidance of Pneumocystis jirovecii Pneumonia in Renal Transplant Recipients. European Journal of Clinical Microbiology & Infec-tious Diseases, 40, 1933-1942. [Google Scholar] [CrossRef] [PubMed]
[8] Zheng, Y., Qiu, X., Wang, T. and Zhang, J. (2021) The Diag-nostic Value of Metagenomic Next-Generation Sequencing in Lower Respiratory Tract Infection. Frontiers in Cellular and Infection Microbiology, 11, 694756. [Google Scholar] [CrossRef] [PubMed]
[9] Wang, J., Han, Y. and Feng, J. (2019) Metagenomic Next-Generation Sequencing for Mixed Pulmonary Infection Diagnosis. BMC Pulmonary Medicine, 19, Article No. 252. [Google Scholar] [CrossRef] [PubMed]
[10] Gaborit, B.J., Tessoulin, B., Lavergne, R.A., Morio, F., Sagan, C., Canet, E., et al. (2019) Outcome and Prognostic Factors of Pneumocystis jirovecii Pneumonia in Immunocompromised Adults: A Prospective Observational Study. Annals of Intensive Care, 9, Article No. 131. [Google Scholar] [CrossRef] [PubMed]
[11] Li, X., Li, Z., Ye, J. and Ye, W. (2023) Diagnostic Performance of Metagenomic Next-Generation Sequencing for Pneumocystis jirovecii Pneumonia. BMC Infectious Diseases, 23, Arti-cle No. 455. [Google Scholar] [CrossRef] [PubMed]
[12] Bateman, M., Oladele, R. and Kolls, J.K. (2020) Diagnosing Pneumocystis jirovecii Pneumonia: A Review of Current Methods and Novel Approaches. Medical Mycology, 58, 1015-1028. [Google Scholar] [CrossRef] [PubMed]
[13] Del Corpo, O., Butler-Laporte, G., Sheppard, D.C., Cheng, M.P., McDonald, E.G. and Lee, T.C. (2020) Diagnostic Accuracy of Serum (1-3)-β-D-Glucan for Pneumocystis jirovecii Pneumonia: A Systematic Review and Meta-Analysis. Clinical Microbiology and Infection, 26, 1137-1143. [Google Scholar] [CrossRef] [PubMed]
[14] Jiang, J., Bai, L., Yang, W., Peng, W., An, J., Wu, Y., et al. (2021) Metagenomic Next-Generation Sequencing for the Diagnosis of Pneumocystis jirovecii Pneumonia in Non-HIV-Infected Patients: A Retrospective Study. Infectious Diseases and Therapy, 10, 1733-1745. [Google Scholar] [CrossRef] [PubMed]
[15] Gu, W., Deng, X., Lee, M., Sucu, Y.D., Arevalo, S., Stryke, D., et al. (2021) Rapid Pathogen Detection by Metagenomic Next-Generation Sequencing of Infected Body Fluids. Nature Medicine, 27, 115-124. [Google Scholar] [CrossRef] [PubMed]
[16] Sun, T., Wu, X., Cai, Y., Zhai, T., Huang, L., Zhang, Y., et al. (2021) Metagenomic Next-Generation Sequencing for Pathogenic Diagnosis and Antibiotic Management of Severe Community-Acquired Pneumonia in Immunocompromised Adults. Frontiers in Cellular and Infection Microbiology, 11, 661589. [Google Scholar] [CrossRef] [PubMed]
[17] Xie, G., Zhao, B., Wang, X., Bao, L., Xu, Y., Ren, X., et al. (2021) Exploring the Clinical Utility of Metagenomic Next-Generation Sequencing in the Diagnosis of Pulmonary Infection. In-fectious Diseases and Therapy, 10, 1419-1435. [Google Scholar] [CrossRef] [PubMed]
[18] Qian, Y.Y., Wang, H.Y., Zhou, Y., Zhang, H.C., Zhu, Y.M., Zhou, X., et al. (2020) Improving Pulmonary Infection Diagnosis with Metagenomic Next Generation Sequencing. Frontiers in Cellular and Infection Microbiology, 10, 567615. [Google Scholar] [CrossRef] [PubMed]
[19] Schmidt, J.J., Lueck, C., Ziesing, S., Stoll, M., Haller, H., Gottlieb, J., et al. (2018) Clinical Course, Treatment and Outcome of Pneumocystis Pneumonia in Immunocompromised Adults: A Retrospective Analysis over 17 Years. Critical Care, 22, Article No. 307. [Google Scholar] [CrossRef] [PubMed]

为你推荐