Deng Zuqun, Tang Yishu, Tu Yixuan, Liu Mei, Cheng Qian, Zhang Jian, Liu Feiyang, Li Xin
Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
Department of Emergency, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
Front Med (Lausanne). 2023 Jun 28;10:1195629. doi: 10.3389/fmed.2023.1195629. eCollection 2023.
Metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF) is gradually being used in hematological malignancy (HM) patients with suspected pulmonary infections. However, negative results are common and the clinical value and interpretation of such results in this patient population require further analysis.
Retrospective analysis of 112 HM patients with suspected pulmonary infection who underwent BALF mNGS and conventional microbiological tests. The final diagnosis, imaging findings, laboratory results and treatment regimen of 29 mNGS-negative patients were mainly analyzed.
A total of 83 mNGS positive and 29 negative patients (15 true-negatives and 14 false-negatives) were included in the study. Compared to false-negative patients, true-negative patients showed more thickening of interlobular septa on imaging ( < 0.05); fewer true-negative patients had acute respiratory symptoms such as coughing or sputum production ( < 0.05) clinically; On the aspect of etiology, drug-related interstitial pneumonia (6/15, 40%) was the most common type of lung lesion in true-negative patients; on the aspect of pathogenesis, false-negative patients mainly missed atypical pathogens such as fungi and tuberculosis (8/14, 57.1%). Regarding treatment, delayed anti-infection treatment occurred after pathogen missing in mNGS false-negative patients, with the longest median time delay observed for anti-tuberculosis therapy (13 days), followed by antifungal therapy (7 days), and antibacterial therapy (1.5 days); the delay in anti-tuberculosis therapy was significantly longer than that in antibacterial therapy ( < 0.05).
For HMs patients with imaging showing thickening of interlobular septa and no obvious acute respiratory symptoms, lung lesions are more likely caused by drug treatment or the underlying disease, so caution should be exercised when performing BALF mNGS. If BALF mNGS is negative but infection is still suspected, atypical pathogenic infections should be considered.
支气管肺泡灌洗术（BALF）的宏基因组下一代测序（mNGS）正逐渐应用于疑似肺部感染的血液系统恶性肿瘤（HM）患者。然而，阴性结果很常见，此类结果在该患者群体中的临床价值及解读需要进一步分析。
对112例接受BALF mNGS和传统微生物检测的疑似肺部感染的HM患者进行回顾性分析。主要分析了29例mNGS阴性患者的最终诊断、影像学表现、实验室检查结果及治疗方案。
本研究共纳入83例mNGS阳性患者和29例阴性患者（15例真阴性和14例假阴性）。与假阴性患者相比，真阴性患者影像学上小叶间隔增厚更明显（<0.05）；临床上真阴性患者出现咳嗽或咳痰等急性呼吸道症状的较少（<0.05）；在病因方面，药物相关性间质性肺炎（6/15，40%）是真阴性患者中最常见的肺部病变类型；在发病机制方面，假阴性患者主要漏检真菌和结核等非典型病原体（8/–14，57.1%）。在治疗方面，mNGS假阴性患者在病原体漏检后出现抗感染治疗延迟，抗结核治疗延迟的中位时间最长（13天），其次是抗真菌治疗（–7天）和抗菌治疗（1.5天）；抗结核治疗延迟明显长于抗菌治疗（<0.05）。
对于影像学显示小叶间隔增厚且无明显急性呼吸道症状的HM患者，肺部病变更可能由药物治疗或基础疾病引起，因此在进行BALF mNGS时应谨慎。如果BALF mNGS为阴性但仍怀疑感染，则应考虑非典型病原体感染。
