宏基因二代测序技术对慢性肺曲霉病病原学诊断的价值

张尧; 缪青; 金文婷; 史庆丰; 苏逸; 马玉燕; 王青青; 潘珏; 胡必杰

doi:10.12025/j.issn.1008-6358.2020.20201183

宏基因二代测序技术对慢性肺曲霉病病原学诊断的价值

Etiological dignostic value of metagenomic next-generation sequencing in chronic pulmonary aspergillosis

摘要

摘要:
目的探讨宏基因二代测序（metagenomic next-generation sequencing，mNGS）技术对慢性肺曲霉病（chronic pulmonary aspergillosis，CPA）病原学诊断的价值。
方法回顾性收集2017年9月至2019年9月复旦大学附属中山医院感染病科收治的78例疑似CPA患者病例资料，采集样本进行常规微生物学培养、血清烟曲霉特异性抗体IgG检测和mNGS，比较3种检测方法的灵敏度和特异度。根据诊断标准，将78例疑似CPA患者最终诊断结果分为CPA组（35例）和非CPA组（43例）。
结果以最终诊断结果为金标准，常规培养法、烟曲霉特异性抗体IgG检测和mNGS的灵敏度分别为28.6%、48.6%和65.7%，特异度分别为93.0%、90.7%和86.0%，其中mNGS的灵敏度显著高于常规培养法（P=0.001）。ROC曲线下面积分别为0.759、0.696和0.608。
结论在CPA的诊断中，mNGS的灵敏度显著高于常规培养法和烟曲霉特异性抗体IgG检测，且在检测时间上具有明显优势。

Abstract:
Objective To explore the etiological diagnostic value of metagenomic next-generation sequencing (mNGS) in chronic pulmonary aspergillosis (CPA).
Methods 78 cases of suspected CPA patients admitted to the Department of Infectious Diseases of Zhongshan Hospital, Fudan University between September 2017 and September 2019 were retrospectively reviewed. Samples were collected for traditional microbiological culture, serum Aspergillus fumigatus-specific antibody IgG analysis and mNGS, and the diagnostic performance of the three methods were compared. According to the diagnostic criteria, 78 patients with suspected CPA were divided into CPA group(35 cases) and non-CPA group(43 cases).
Results Compared with the final diagnosis, the sensitivity of mNGS, A. fumigatus-specific antibody IgG analysis and traditional culture method in the diagnosis of CPA were 65.7%, 48.6%, and 28.6%, respectively; and the specificity were 86.0%, 90.7%, and 93.0%, respectively. The sensitivity of mNGS was significantly higher than that of traditional culture method (P=0.001).The area under curve (AUC) of mNGS, A. fumigatus-specific antibody IgG analysis and traditional culture method were 0.759, 0.696, and 0.608, respectively.
Conclusions In the diagnosis of CPA, the sensitivity of mNGS is significantly higher than that of traditional culture method and A. fumigatus-specific antibody IgG analysis. At the same time, it has obvious advantages in detection time.

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