摘要
目的探究经宏基因组二代测序(mNGS)技术诊断的非HIV耶氏肺孢子菌肺炎(PJP)患者的临床特征。方法回顾性分析2021年1月1日—9月30日在徐州医科大学附属医院呼吸与危重症医学科住院的,经支气管肺泡灌洗液(BALF)二代测序确诊的9例PJP患者的临床资料,观察其临床表现、实验室检查指标、影像学表现、合并其他基础疾病、治疗及转归、mNGS检出病原学情况等。结果9例PJP患者中,男性7例,女性2例,年龄17~70岁,平均年龄(54±15)岁。其中8例合并基础疾病,1例无基础疾病。4例患者长期口服激素及免疫抑制剂,2例仅长期口服激素。临床表现为发热、咳嗽、呼吸困难,胸部CT表现为斑片影,大部分伴磨玻璃密度影,同时伴有多发结节影、蜂窝影等。9例PJP患者均存在低氧血症,氧合指数平均值为(185±82)mmHg,外周血淋巴细胞计数均下降,平均值为(0.88±0.39)×10^(9)/L,其中8例CD4+T淋巴细胞计数明显下降,平均值为(250±187)个/μl,(1,3)-β-D-葡聚糖水平、乳酸脱氢酶(LDH)水平均显著升高,平均值分别为(347±193)ng/L、(819±420)U/L。9例患者中5例(55.6%)ΒALF标本mNGS检出耶氏肺孢子菌,2例痰和血标本(44.4%)mNGS同时检出耶氏肺孢子菌,2例患者仅痰标本mNGS检出耶氏肺孢子菌,但结合典型临床和影像学表现诊断为PJP,mNGS还检出其余多种病毒、多重耐药菌以及其他真菌等。经复方磺胺甲噁唑和卡泊芬净治疗后,好转4例,死亡5例。结论非HIV感染免疫抑制患者罹患PJP的基础疾病多样,其发生与接受糖皮质激素及免疫抑制剂有关,疾病严重程度较重,混合机会性感染常见,病死率较高,mNGS诊断相较于常规实验室检查方法,有更高的敏感性与特异性,可作为PJP的有效诊断手段。
Objective To investigate the clinical features of patients with Pneumocystis jirovecii pneumonia(PJP)diagnosed by metagenomic second-generation sequencing.Methods A total of nine PJP patients who were admitted to Department of Respiratory and Critical Care Medicine,the Affiliated Hospital of Xuzhou Medical University from January 1,2021 to September 30,2021 and diagnosed by second-generation sequencing using bronchoalveolar lavage fluid(BALF)were selected and their clinical data were retrospectively analyzed.Their clinical manifestations,laboratory examination indicators,imaging performance,other basic diseases,treatment and outcome,and the etiology of metagenomic next-generation sequencing(mNGS)were observed.Results Among the nine PJP patients,there were seven men and two women,aged 17—70 years,with an average age of 54±15 years.There were eight patients with basic diseases and one without basic disease.Four patients took oral hormones and immunosuppressants for a long time,while only two patients were given long-term oral hormones alone.Their clinical manifestations included fever,cough,and dyspnea.According to chest CT scan,patch shadow was menifested,most of which were accompanied by ground glass density shadow,together with multiple nodular shadows and honeycomb shadows.Nine PJP patients presented hypoxemia,with an average oxygenation index of(185±82)mmHg,and their peripheral blood lymphocyte counts decreased,with an average value of(0.88±0.39)×10^(9)/L,where eight cases showed significant decreases in CD4^(+)T lymphocyte count,with an average value was(250±187)cells/μl,and remarkable increase in(1,3)-βD-dextran level and lactate dehydrogenase level,with the averages of(347±193)ng/L and(819±420)U/L,respectively.Among the nine patients,Pneumocystis jirovecii were detected by mNGS in the BALF of five patients(55.6%),in both the sputum and mNGS of four patients(44.4%).Two patients were Pneumocystis jirovecii positive in the sputum alone,but diagnosed with PJP,based on typical clinical and imaging menifestation.Furthermore,other viruses,multidrug-resistant bacteria and other fungi were detected.After treatment with compound sulfamethoxazole and carboplafencin,four cases improved and five cases died.Conclusions Non-HIV-infected immunosuppressed patients suffer from a variety of underlying diseases of PJP,which is related to administration of glucocorticoids and immunosuppressants.The severity of the disease is severe,and mixed opportunistic infections are common,with a high case fatality rate.Compared with conventional laboratory tests,mNGS has high sensitivity and specificity,and may be an effective diagnosis method for PJP.
作者
孙宜田
奚斌
张毛为
张蕊
陈碧
SUN Yitian;XI Bin;ZHANG Maowei;ZHANG Rui;CHEN Bi(Department of Respiratory and Critical Care Medicine,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China)
出处
《徐州医科大学学报》
CAS
2022年第8期600-606,共7页
Journal of Xuzhou Medical University
基金
江苏省“六大人才高峰”高层次人才项目(WSN-081)
徐州市科技计划项目(KC21237)。
关键词
宏基因组二代测序技术
肺孢子菌肺炎
临床特征
metagenomic next-generation sequencing
Pneumocystis jirovecii pneumonia
clinical characteristic
