Zhang W, She D Y, Xie X W, Zheng H D, Pang J L, Wei X Y, Wang H Y
Department of Emergency Medicine, the Fourth Medical Center, Chinese PLA General Hospital, Beijing 100048, China.
Department of Respiratory and Critical Care Medicine, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2020 Oct 12;43(10):844-849. doi: 10.3760/cma.j.cn112147-20200416-00510.
To evaluate the clinical value of next-generation sequencing in the diagnosis of Pneumocystis pneumonia in non-HIV infected patients. A retrospective study was conducted on the diagnosis and treatment of Pneumocystis pneumonia in 5 non-HIV patients in the Fourth Medical Center of the General Hospital of the PLA from September 1, 2017 to September 1, 2018. Next-generation sequencing of BALF were compared with the traditional laboratory microbiological test, and the advantages of the next-generation sequencing in the diagnosis of Pneumocystis pneumonia in non-HIV infected patients were analyzed. There were 3 males and 2 females, with a mean age (48±6) years. Three patients had membranous nephropathy, a patient had tuberculous meningitis, and a patient had esophageal cancer after radiotherapy and chemotherapy. All patients had glucocorticoid medication history before. The clinical manifestations were fever, cough and dyspnea. The chest CT mainly showed bilateral lung ground glass shadows. All the results of 1, 3-β-D-glucan test were more than 1 000 ng/L. Bronchoalveolar lavage was performed in the 5 cases, and Pneumocystis cysts were found in 1 BALF by Gomori's methenamine silver nitrate staining, and the DNAs of Pneumocystis and human herpesvirus were detected in 5 BALFs by next-generation sequencing. All patients were treated with sulfamethoxazole/trimethoprim (orally, 1.44 g, q8 h) for 23 to 72 days (median 33 days), and with ganciclovir(Ⅳ, 250 mg q12 h) for 6 to 22 days (median 15 days). The chest CT manifestations and symptoms were improved after treatment, without death. The next-generation sequencing of BALF is more specific and sensitive in the diagnosis of Pneumocystis pneumoniae in non-HIV patients. It is faster, more comprehensive and more accurate than the traditional laboratory test, and could be widely used as a PCP diagnosis technique.
评估二代测序技术在非HIV感染患者肺孢子菌肺炎诊断中的临床价值。对2017年9月1日至2018年9月1日解放军总医院第四医学中心收治的5例非HIV感染肺孢子菌肺炎患者的诊断和治疗情况进行回顾性研究。将支气管肺泡灌洗术（BALF）的二代测序结果与传统实验室微生物学检测结果进行比较，分析二代测序技术在非HIV感染患者肺孢子菌肺炎诊断中的优势。5例患者中男性3例，女性2例，平均年龄（48±6）岁。3例患有膜性肾病，1例患有结核性脑膜炎，1例为放化疗后食管癌患者。所有患者既往均有糖皮质激素用药史。临床表现为发热、咳嗽、呼吸困难。胸部CT主要表现为双肺磨玻璃影。1,3-β-D-葡聚糖检测结果均大于1 000 ng/L。5例患者均行支气管肺泡灌洗术，改良Gomori六胺银染色法在1例BALF中发现肺孢子菌包囊，二代测序技术在5例BALF中均检测到肺孢子菌及人疱疹病毒DNA。所有患者均接受复方磺胺甲恶唑（口服，1.44 g，每8小时1次）治疗23至72天（中位时间33天），更昔洛韦（静脉滴注，250 mg，每12小时1次）治疗6至22天（中位时间15天）。治疗后胸部CT表现及症状均改善，无死亡病例。BALF的二代测序技术在非HIV感染患者肺孢子菌肺炎诊断中具有更高的特异性和敏感性，比传统实验室检测更快、更全面、更准确，可作为肺孢子菌肺炎的诊断技术广泛应用。
