中国真菌学杂志

目的 探讨靶向高通量测序(targeted next-generation sequencing,tNGS)技术对非HIV感染患者耶氏肺孢子菌肺炎的诊断价值。方法 回顾性分析2022年1月—2024年12月第九〇九医院接受tNGS检查的非HIV感染耶氏肺孢子菌肺炎(Pneumocystis jirovecii pneumonia,PJP)患者及非HIV、非PJP的肺炎患者临床资料。以临床复合诊断为金标准，分析tNGS、聚合酶链反应(polymerase chain reaction,PCR)、(1,3)-β-D-葡聚糖[(1,3)-β-D-glucan,BDG]对患者支气管肺泡灌洗液耶氏肺孢子菌及其他共病原体检出情况及诊断效能。结果 共纳入115例非HIV感染的肺炎患者，其中54例为PJP患者。以临床复合诊断为金标准，tNGS诊断PJP的灵敏度、特异度、阴性预测值、阳性预测值、准确度均为100%，高于PCR与血清BDG检测对应值。54例PJP患者中，tNGS检测出单纯耶氏肺孢子菌感染8例(14.81%)，混合感染46例(85.19%),tNGS对混合感染的检出率高于常规病原检测(85.19%vs. 66.67%,P=0.024)。tNGS在支气管肺泡灌洗液中共检出147例次病原体，除耶氏肺孢子菌外，以EB病毒（13例）、白念珠菌（11例）、人疱疹病毒5型（9例）、鲍曼不动杆菌（8例）较为常见。结论 tNGS对非HIV感染PJP患者诊断准确，且在混合感染样本的鉴别检测中具有优势。

Objective To evaluate the diagnostic value of targeted next-generation sequencing(tNGS) in Pneumocystis jirovecii pneumonia(PJP) in non-HIV-infected patients. Methods Clinical data were retrospectively analyzed for non-HIV-infected PJP patients and non-HIV/non-PJP pneumonia patients who underwent tNGS testing in No.909 Hospital from January 2022 to December 2024. Using clinical composite diagnosis as the gold standard, the diagnostic performance of tNGS, polymerase chain reaction(PCR), and serum(1,3)-β-D-glucan(BDG) assays for detecting Pneumocystis. jirovecii and co-pathogens in bronchoalveolar lavage fluid(BALF) was evaluated. Results A total of 115 non-HIVinfected pneumonia patients were included, including 54 PJP cases. Compared to the gold standard, tNGS demonstrated 100% sensitivity, specificity, negative predictive value, positive predictive value, and accuracy for PJP diagnosis, surpassing the corresponding values from PCR and serum BDG. Among the 54 PJP patients, tNGS identified 8 cases(14.81%) of simple Pneumocystis jirovecii infection and 46 cases(85.19%) of mixed infections. The detection rate of tNGS for mixed infection was significantly higher than conventional pathogen testing(85.19% vs. 66.67%, P=0.024). In BALF samples, tNGS detected a total of 147 pathogen. Apart from Pneumocystis jirovecii, the most common pathogens were Epstein-Barr virus(13 cases), Candida albicans(11 cases), Human herpesvirus-5(9 cases), and Acinetobacter baumannii(8 cases). Conclusion tNGS provides accurate diagnosis of PJP in non-HIV-infected patients and offers advantages in identifying mixed infections.