Qin Lisha, Liang Mengyuan, Song Jianping, Chen Ping, Zhang Shujing, Zhou Yaya, Li Hui, Tang Jian, Ma Yanling, Yang Bohan, Xu Juanjuan, Zhang Jianchu
Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China.
Department of Respiratory and Critical Care Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, People's Republic of China.
Infect Drug Resist. 2025 Jan 17;18:329-340. doi: 10.2147/IDR.S494558. eCollection 2025.
To evaluate the diagnostic performance and clinical impact of targeted next-generation sequencing (tNGS) in patients with suspected lower respiratory tract infections.
Following propensity score matching, we compared the diagnostic performances of tNGS and metagenomic next-generation sequencing (mNGS). Furthermore, the diagnostic performance of tNGS was compared with that of culture, and its clinical impact was assessed.
After propensity score matching, the coincidence rate of tNGS was comparable to that of mNGS (82.9% vs 73.9%, P=0.079). The detection rates for bacterial, viral, fungal, and mixed infections were not significantly different (P>0.05). Bacterial-viral co-infection (16.7%) was the most common mixed infection detected by tNGS. tNGS showed a higher detection rate than culture (75.2% vs 19.0%, P<0.01). The positive detection rate by tNGS was not significantly different between immunocompromised and immunocompetent patients (88.6% vs 80.5%, P=0.202), but was significantly higher than that by culture (P<0.001). Moreover, 65 patients (44.5%) had their medications modified based on the tNGS results, and the majority exhibited notable improvement regardless of treatment adjustment.
tNGS performs comparably to mNGS and surpasses culture in detecting lower respiratory tract infections. Nevertheless, tNGS is faster and more cost-effective than mNGS, making it highly significant for guiding rational treatment.
评估靶向二代测序（tNGS）在疑似下呼吸道感染患者中的诊断性能及临床影响。
在进行倾向得分匹配后，我们比较了tNGS和宏基因组二代测序（mNGS）的诊断性能。此外，还将tNGS的诊断性能与培养法进行了比较，并评估了其临床影响。
倾向得分匹配后，tNGS的符合率与mNGS相当（82.9%对73.9%，P = 0.079）。细菌、病毒、真菌及混合感染的检出率无显著差异（P>0.05）。细菌-病毒合并感染（16.7%）是tNGS检测到的最常见混合感染。tNGS的检出率高于培养法（75.2%对19.0%，P<0.01）。免疫功能低下和免疫功能正常患者中tNGS的阳性检出率无显著差异（88.6%对80.5%，P = 0.202），但显著高于培养法（P<0.001）。此外，65例患者（44.5%）根据tNGS结果调整了用药，无论治疗调整如何，大多数患者均有明显改善。
tNGS在检测下呼吸道感染方面与mNGS表现相当，且优于培养法。然而，tNGS比mNGS更快且更具成本效益，对指导合理治疗具有重要意义。
