摘要
目的:探讨宏基因组二代测序(metagenomic next-generation sequencing,mNGS)在肺诺卡菌病诊断中的应用价值,以提高临床医生对该病的诊治认识。方法:收集2022年1月至2023年8月期间,福建省南安市医院通过mNGS确诊为肺诺卡菌病的11例患者的临床资料,分析其临床特征、病原学诊断情况、治疗及预后。结果:11例患者中,男性9例,女性2例,年龄41-73岁,平均年龄(55±10)岁。10例患者合并基础疾病,其中1例接受激素治疗,另1例无基础疾病。临床表现包括咳嗽、咳痰、呼吸困难、发热、胸闷、咯血等,2例并发呼吸衰竭,1例并发肝功能异常。胸部CT表现为斑片状阴影、结节影、胸膜增厚、胸腔积液、空洞、支气管扩张及纵隔淋巴结肿大。痰培养、肺泡灌洗液或肺穿刺液均未培养出诺卡菌。通过支气管肺泡灌洗液行mNGS确诊9例,通过经皮肺穿刺组织行mNGS确诊2例,中位确诊时间为9天。所有患者均接受以甲氧苄啶-磺胺甲噁唑(TMP-SMZ)为主要方案的抗感染治疗,10例好转出院,1例自行转至外院治疗失访。结论:肺诺卡菌病的临床表现及胸部CT特征缺乏特异性,易导致漏诊和误诊。mNGS作为一种新型病原微生物检测手段,能够快速、高效地诊断肺诺卡菌病,有助于早诊早治,从而降低病死率。。
ObjectiveTo explore the clinical diagnostic value of metagenomic next-generation sequencing(mNGS)in pulmonary nocardiosis,in order to improve the management of this disease for physicians.MethodsA retrospective study was conducted to analyze the clinical data of 11 patients diagnosed with pulmonary nocardiosis through mNGS at The Hospital of Nanan City from January 2022 to August 2023.ResultsAmong the 11 patients,9 were male and 2 were female,aged 41 to 73 years,with an average age of 55±10 years.Ten patients had underlying diseases,with one patient receiving steroid treatment and one patient without any underlying diseases.Clinical manifestations included cough,sputum production,dyspnea,fever,chest tightness,and hemoptysis.Two cases were complicated by respiratory failure and one case by liver dysfunction.Chest CT findings included patchy shadows,nodular shadows,pleural thickening,pleural effusion,cavities,bronchiectasis,and mediastinal lymphadenopathy.Nocardia was not cultured from sputum,bronchoalveolar lavage fluid,or lung puncture fluid.Nine cases were diagnosed through mNGS of bronchoalveolar lavage fluid,and two cases were diagnosed through mNGS of percutaneous lung puncture tissue,with a median diagnosis time of 9 days.All patients received anti-infective treatment based on trimethoprim-sulfamethoxazole(TMP-SMZ).Ten patients improved and were discharged,and one patient was lost to follow-up after transferring to another hospital.ConclusionThe clinical manifestations and chest CT characteristics of pulmonary nocardiosis lack specificity,making it prone to misdiagnosis and missed diagnosis.As a novel pathogen detection method,mNGS can rapidly and efficiently diagnose pulmonary nocardiosis,aiding in early diagnosis and treatment,thereby reducing the mortality rate.
出处
《黑龙江中医药》
2024年第2期9-12,共4页
Heilongjiang Journal of Traditional Chinese Medicine
关键词
肺奴卡菌
临床特点
宏基因组二代测序
pulmonary nocardiosis
clinical characteristics
metagenomic next-generation sequencing
