实用器官移植电子杂志 ›› 2024, Vol. 12 ›› Issue (3): 204-208.DOI: 10.3969/j.issn.2095-5332.2024.03.003

• 论著 • 上一篇    下一篇

宏基因组二代测序技术在肾移植术后肺部感染诊治中的临床应用

李甲志,欧升凇,覃超宇,韦小娇,庞飞雄,冉果,杨建荣,赖彦华   

  1. 广西壮族自治区人民医院移植科,广西 南宁 530021

  • 出版日期:2024-05-20 发布日期:2024-05-20
  • 基金资助:

    广西科技基地和人才专项(桂科 AD22035101);

    广西卫健委科研课题(Z-A20230079) 

Clinical application of metagenomic second-generation sequencing technology in the diagnosis and treatmentof pulmonary infections after kidney transplantation 

Li Jiazhi, Ou Shengsong, Qin Chaoyu, Wei Xiaojiao, Pang Feixiong, Ran Guo, Yang Jianrong, Lai Yanhua.    

  1. Department ofTransplantation, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi,China. 

  • Online:2024-05-20 Published:2024-05-20

摘要:

目的 探讨宏基因组二代测序技术(metagenomic second-generation sequencing technology,mNGS)在肾移植术后肺部感染诊治中的临床价值,为疾病精准诊治提供参考。方法 收集 2020 年 1 月 1 日 至 2023 年 12 月 15 日广西壮族自治区人民医院移植科 124 例肾移植术后肺部感染患者的临床资料,根据是否采用 mNGS 检测病原体分为测序组(60 例)和传统组(64 例),并对比分析两组病原体检出率、抗菌药物使用强度、住院时间、住院费用、无创呼吸支持概率、病情等级、重症率、病死率等指标。结果 两组患者性别、年龄、术后发病时间、基础疾病、入院病情(SMART-COP 评分)、治疗前肌酐、他克莫司浓度、甲强龙方案差异均无统计学意义(P>0.05)。测序组患者检出病原体、混合型肺部感染明显高于传统组(P<0.05),但两组间传统方法检测结果差异无统计学意义(P>0.05)。测序组亚组发现,mNGS 方法检出支气管肺泡灌洗液病原体、混合型肺部感染、耶氏肺孢子菌明显高于传统培养 + 涂片方法(P<0.05)。测序组出现 1 例不良反应,无纤支镜相关并发症,传统组出现 2 例不良反应。测序组抗菌药物使用强度、病死率、病情高峰、出院肌酐、住院时间、住院费用均明显低于传统组患者(P<0.05),两组患者无创呼吸支持率和重症率相似(P>0.05)。结论 宏基因组二代测序技术可为肾移植术后肺部感染诊治提供精准方向,改善患者临床预后,值得临床推广。 

关键词:

肾移植 , 肺部感染 , 宏基因组二代测序

Abstract:

ObjectiveTo Explore the clinical value of metagenomic second-generation sequencing technology (mNGS) in the diagnosis and treatment of pulmonary infections after kidney transplantation, and to provide reference for precise diagnosis and treatment of diseases. MethodsThe clinical data of 124 kidneytransplant recipients with pulmonary infections were completed from the Department of Transplantation of the People's Hospital of Guangxi Zhuang Autonomous Region from January 1,2020 to December 15,2023. According to the pathogen detection method of mNGS, the patients were divided into sequencing group (60 cases) and traditional group (64 cases). The pathogen detection rate, antibiotic use intensity, hospitalization time, hospitalization cost, non-invasive respiratory support rate, disease grade, severe illness rate, mortality rate, and other indicators were retrospectively analyzed between traditional group and sequencing group. ResultsThere was no statistically significant difference in gender, age,postoperative onset time, underlying disease, admission status of pulmonary infection (SMART-COP score), pre-treatment creatinine, tacrolimus concentration, and methylprednisolone regimen between the two groups of patients (P>0.05). The detection of pathogens and mixed pulmonary infections in the sequencing group was significantly higher than that in the traditional group (P < 0.05). However, there was no statistically significant difference in the results of traditional detection methods between the two groups (P>0.05). There was statistically significant difference in the bronchoalveolar lavage fluid pathogens, mixed lung infections, pneumocystis jejun between the mNGS and culture + smear methods (P<0.05). One adverse reaction occurred in the sequencing group, with no complications related to bronchoscopy, and two adverse reactions occurred in the traditional group. In the sequencing group, the intensity of antibiotic use, mortality,peak pulmonary infection progression, discharge creatinine, length of hospital stay, and hospitalization costs were significantly lower than those of the traditional group (P < 0.05), and the non-invasive respiratory support for patients and critically ill patients were similar to the traditional group (P>0.05). ConclusionmNGS can provide precise directions for the diagnosis and treatment of kidney transplant recipients with pulmonary infections, it improves patient clinical prognosis, and is worthy of clinical promotion. 

Key words:

Kidney transplantation , Pulmonary infection , Metagenomics metagenomic second-generation sequencing