基于宏基因组新一代测序技术诊断无人类免疫缺陷病毒感染患者的耶氏肺孢子菌肺炎：一项双中心回顾性倾向匹配研究

Metagenomic next-generation sequencing-based diagnosis of Pneumocystis jirovecii pneumonia in patients without human immunodeficiency virus infection: A dual-center retrospective propensity matched study.

作者信息

Wang Jin-Zhu, Wang Jiang-Bo, Yuan Ding, Sun Chang-Hua, Hou Lin-Lin, Zhang Yan, Yang Xiang-Hong, Xie Hong-Xiang, Gao Yan-Xia

机构信息

Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang 310014, China; Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450001, China.

Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang 310014, China.

出版信息

J Infect Public Health. 2025 Sep;18(9):102831. doi: 10.1016/j.jiph.2025.102831. Epub 2025 May 19.

DOI:10.1016/j.jiph.2025.102831

PMID:40472476

Abstract

BACKGROUND

Pneumocystis jirovecii pneumonia (PJP), caused by Pneumocystis jirovecii (PJ), is an opportunistic infection prevalent in clinical settings. However, large-scale studies on the efficacy of metagenomic next-generation sequencing (mNGS)-based diagnosis of PJP in patients without human immunodeficiency virus infection (HIV) are lacking.

METHODS

The study included 168 patients diagnosed with either PJP (84) or other pneumonia types (non-PJP patients; 84) who underwent mNGS-mediated bronchoalveolar lavage fluid (BALF) analysis, Gomori methenamine silver (GMS) staining and peripheral blood 1,3-beta-D-glucan (BDG) testing. Additionally, patients with PJP were categorized into survival (n = 55) and non-survival (n = 29) groups based on a 28-day in-hospital outcome to compare clinical characteristics, inflammatory markers, PJ sequence counts in BALF, and serum BDG levels.

RESULTS

Serum BDG levels, the proportion of patients with serum BDG of > 60 pg/mL and > 200 pg/mL were notably higher in the PJP group compared with that in the non-PJP group (all P< 0.05). The sensitivity and specificity of mNGS in diagnosing PJP were higher than those of serum BDG testing (sensitivity: 100 % vs. 63.0 %; specificity: 96.4 % vs. 90.4 %; both P< 0.05). The most common coinfection was viral (30.9 %), followed by bacterial-viral coinfections (13.0 %). Treatment regimens were altered for 83.3 % of patients based on the mNGS results. The patients in the non-survival group showed markedly higher serum BDG levels (142.5 [32.7, 277.7] vs. 123.0 [34.0, 164.0]) and a higher proportion of PJ sequence counts of > 1 × 10 (13.7 % vs. 0, P= 0.005) relative to those in the survival group.

CONCLUSION

The mNGS showed superior performance over serum BDG testing and GMS staining in diagnosing PJP in non-HIV patients and identified a broader range of coinfections.

摘要

背景

由耶氏肺孢子菌（PJ）引起的耶氏肺孢子菌肺炎（PJP）是临床常见的机会性感染。然而，目前缺乏关于宏基因组下一代测序（mNGS）在诊断未感染人类免疫缺陷病毒（HIV）患者的PJP疗效的大规模研究。

方法

该研究纳入了168例诊断为PJP（84例）或其他肺炎类型（非PJP患者；84例）的患者，这些患者均接受了mNGS介导的支气管肺泡灌洗（BALF）分析、吉姆萨甲胺银（GMS）染色和外周血1,3-β-D-葡聚糖（BDG）检测。此外，根据患者28天的住院结局，将PJP患者分为生存组（n = 55）和非生存组（n = 29），以比较临床特征、炎症标志物、BALF中PJ序列计数和血清BDG水平。

结果

PJP组血清BDG水平、血清BDG>60 pg/mL和>200 pg/mL的患者比例显著高于非PJP组（均P<0.05）。mNGS诊断PJP的敏感性和特异性高于血清BDG检测（敏感性：100%对63.0%；特异性：96.4%对90.4%；均P<0.05）。最常见的合并感染是病毒感染（30.9%），其次是细菌-病毒合并感染（13.0%）。83.3%的患者根据mNGS结果调整了治疗方案。非生存组患者的血清BDG水平显著高于生存组（142.5 [32.7, 277.7]对123.0 [34.0, 164.0]），且BALF中PJ序列计数>1×10的比例更高（13.7%对0，P = 0.005）。