宏基因组二代测序在肾移植患者肺部感染诊断中的应用

doi:10.3969/j.issn.1673-8640.2026.01.015

摘要/Abstract

摘要：

目的探讨宏基因组二代测序（mNGS）检测肾移植患者支气管肺泡灌洗液（BALF）病原体对肺部感染的诊断价值。方法选取2020年7月—2023年10月郑州人民医院50例肾移植术后发生肺部感染的患者。收集患者的临床资料。收集患者肺泡灌洗液样本，同时采用mNGS和常规方法检测病原体，分析2种方法检测结果的一致性。评估mNGS对于细菌、真菌、病毒和混合感染的诊断价值。结果 50例患者BALF中共检出59种病原体，其中mNGS检出56种，常规方法检出22种，mNGS病原体检出率（98.0%）高于常规方法（60.0%）（P<0.001）。2种方法检测结果一致率为62.0%，一致性较差（Kappa=0.059）；mNGS细菌、真菌、病毒阳性检出率分别为74.0%、62.0%、86.0%，均高于常规方法（阳性检出率分别为 32.0%、 16.0%、 36.0%）（P<0.05）；mNGS对于混合感染的检出率（86.0%）也高于常规方法（24.0%）（P<0.001）。mNGS联合常规方法混合感染检出率为91.84%。结论 mNGS可以显著提高肾移植后肺部感染患者BALF病原体的检出率。mNGS联合常规方法在混合感染诊断方面具有优势，可为早期精准识别病原体提供有价值的依据。

关键词: 宏基因组二代测序, 肾移植, 肺部感染

Abstract:

Objective To investigate the diagnostic value of metagenomic next-generation sequencing （mNGS） in determining pathogens in bronchoalveolar lavage fluid （BALF） of renal transplant patients for pulmonary infections. Methods Totally，50 patients with pulmonary infections after renal transplantation from Zhengzhou People's Hospital from July 2020 to October 2023 were enrolled. The clinical data were collected.The BALF samples were collected，and mNGS and conventional methods were used to determine pathogens simultaneously. The consistency of the determination results of the 2 methods was analyzed. The diagnostic value of mNGS for bacterial，fungal，viral and mixed infections was evaluated. Results A total of 59 pathogens were determined in the BALF samples of 50 patients. Among them，mNGS determined 56 pathogens，while the conventional method determined 22 pathogens. The determination rate of pathogens by mNGS（98.0%）was higher than that by the conventional method（60.0%）（P<0.001）. The consistency rate of the determination results of the 2 methods was 62.0%，and the consistency was poor（Kappa=0.059）. The positive determination rates of bacteria，fungi and viruses by mNGS were 74.0%，62.0% and 86.0%，respectively，which were higher than those by the conventional method（the positive determination rates were 32.0%，16.0% and 36.0%，respectively）（P<0.05）. The determination rate of mixed infections by mNGS（86.0%）was also higher than that by the conventional method（24.0%）（P<0.001）. Moreover，the combined determination rate of mNGS and conventional method for mixed infections was 91.84%. Conclusions The mNGS can increase the determination rate of pathogens in BALF samples of renal transplant patients with pulmonary infections. The mNGS combined with conventional methods has advantages in the diagnosis of mixed infections and can provide a reference for early and precise identification of pathogens.

Key words: Metagenomic next-generation sequencing, Renal transplantation, Pulmonary infection

中图分类号:

R446.7

王南, 杨珍珍, 谢昕, 王慧, 王萍, 宋银森. 宏基因组二代测序在肾移植患者肺部感染诊断中的应用[J]. 检验医学, 2026, 41(1): 78-83.

WANG Nan, YANG Zhenzhen, XIE Xin, WANG Hui, WANG Ping, SONG Yinsen. Application of metagenomic next-generation sequencing in diagnosing pulmonary infections in renal transplant patients[J]. Laboratory Medicine, 2026, 41(1): 78-83.

图/表 4

参考文献 27

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项目	mNGS/例	常规检测/例	χ2值	P值
单一感染			7.895	0.005
细菌	2	7
真菌	0	2
病毒	4	8
特殊病原体	0	1
混合感染			32.828	<0.001
细菌+真菌	4	2
细菌+病毒	12	6
真菌+病毒	8	3
细菌+真菌+病毒	19	1

项目	mNGS/例	常规检测/例	χ2值	P值
单一感染			7.895	0.005
细菌	2	7
真菌	0	2
病毒	4	8
特殊病原体	0	1
混合感染			32.828	<0.001
细菌+真菌	4	2
细菌+病毒	12	6
真菌+病毒	8	3
细菌+真菌+病毒	19	1