Department of Respiratory Medicine, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China.
Department of Clinical Laboratory Medicine, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China.
Front Cell Infect Microbiol. 2024 Oct 29;14:1446814. doi: 10.3389/fcimb.2024.1446814. eCollection 2024.
To evaluate the diagnostic value of metagenomic next-generation sequencing (mNGS) in pulmonary cryptococcosis (PC) using bronchoalveolar lavage fluid (BALF) and lung biopsy tissue specimens.
In this retrospective study, 321 patients diagnosed with lower respiratory tract diseases who underwent mNGS using BALF and LBT samples, between January 2021 and December 2023 were included. Individuals were classified into PC and non-PC groups according to the diagnostic criteria for PC, and conventional fungal cultures were performed. A serum/BALF cryptococcal antigen (CrAg) test was performed in some patients with PC. The diagnostic efficiencies of three methods for PC (mNGS, conventional culture, and CrAg) were compared. Additionally, two mNGS methods were used in this study: original mNGS (OmNGS, testing time from January 2021 to December 2022) and modified mNGS (MmNGS, testing time from January to December 2023). The diagnostic efficiency of the two mNGS methods on PC was simultaneously compared.
Among the 321 patients, 23 (7.2%) had PC and 298 (92.8%) did not. Compared with the composite reference standard for PC diagnosis, the sensitivity, specificity, and accuracy of mNGS for PC were 78.3% (95% confidence interval [CI], 55.8%-91.7%), 98.7% (95% CI, 96.4%-99.6%), and 97.2% (95% CI, 94.7%-98.7%), respectively. The sensitivity of mNGS was similar to that of CrAg (80.0%, 12/15) ( > 0.05). The diagnostic sensitivity of both mNGS and CrAg was higher than that of conventional culture (35.0%, 7/20) ( = 0.006, = 0.016), and the combined detection of mNGS and CrAg further improved the diagnostic sensitivity of PC (93.3%, 14/15). The area under the receiver operating characteristic curve of mNGS was superior to that of conventional culture (0.885 vs. 0.675). In addition, the diagnostic sensitivity of PC was higher than that of OmNGS ( = 0.046).
The sensitivity of mNGS is better than that of conventional culture. The combination of mNGS and CrAg improves the testing sensitivity of . MmNGS could further improve the detection of . Conventional PC detection methods are indispensable and mNGS can be used as a rapid and accurate auxiliary diagnostic method for PC.
评估宏基因组下一代测序（mNGS）在支气管肺泡灌洗液（BALF）和肺活检组织标本中对肺隐球菌病（PC）的诊断价值。
在这项回顾性研究中，纳入了 2021 年 1 月至 2023 年 12 月期间，因下呼吸道疾病接受 mNGS 检测的 321 例患者。根据 PC 的诊断标准，将患者分为 PC 组和非 PC 组，并进行常规真菌培养。部分 PC 患者进行了血清/支气管肺泡灌洗液隐球菌抗原（CrAg）检测。比较了 mNGS、常规培养和 CrAg 三种方法对 PC 的诊断效率。此外，本研究采用了两种 mNGS 方法：原始 mNGS（OmNGS，检测时间为 2021 年 1 月至 2022 年 12 月）和改良 mNGS（MmNGS，检测时间为 2023 年 1 月至 12 月）。同时比较了两种 mNGS 方法对 PC 的诊断效率。
321 例患者中，23 例（7.2%）患有 PC，298 例（92.8%）未患有 PC。与 PC 诊断的综合参考标准相比，mNGS 对 PC 的敏感度、特异度和准确度分别为 78.3%（95%CI，55.8%-91.7%）、98.7%（95%CI，96.4%-99.6%）和 97.2%（95%CI，94.7%-98.7%）。mNGS 的灵敏度与 CrAg（80.0%，12/15）相似（>0.05）。mNGS 和 CrAg 的诊断灵敏度均高于常规培养（35.0%，7/20）（=0.006，=0.016），mNGS 和 CrAg 的联合检测进一步提高了 PC 的诊断灵敏度（93.3%，14/15）。mNGS 的受试者工作特征曲线下面积优于常规培养（0.885 比 0.675）。此外，PC 的 mNGS 诊断灵敏度高于 OmNGS（=0.046）。
mNGS 的灵敏度优于常规培养。mNGS 和 CrAg 的联合检测提高了检测的灵敏度。MmNGS 可以进一步提高对的检测。传统的 PC 检测方法不可或缺，mNGS 可作为 PC 的快速、准确的辅助诊断方法。
