使用负的mNGS优化治疗给药策略,导致对皮质类固醇敏感的扩散性帕伦基马性肺病
Chuwei Jing1, Yuchen Ding1, Ji Zhou1
1Department of Respiratory Medicine, Jiangsu Province Hospital/Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China.
iScience
|July 12, 2024
概括
甲基因组下一代测序 (mNGS) 有助于调整扩散性副细胞肺部疾病 (DPLD) 的抗生素和皮质类固醇治疗方法. 负的mNGS结果引导了大多数患者的治疗变化,改善了护理.
科学领域:
- 肺部医学 肺部医学
- 传染性疾病 传染性疾病
- 基因组学就是基因组学.
背景情况:
- 扩散性帕伦基马性肺病 (DPLDs) 需要精确的抗生素和皮质类固醇管理.
- 下一代元基因组测序 (mNGS) 为指导DPLD治疗提供了一个潜在的工具.
- 皮质类固醇反应是管理DPLD患者的关键因素.
研究的目的:
- 为了评估阴性mNGS结果的临床实用性,指导DPLD患者的治疗调整.
- 调查mNGS对DPLD的抗生素和皮质类固醇治疗的影响.
- 探索肺部微生物群与DPLD严重程度之间的关系.
主要方法:
- 对41名DPLD患者的回顾性分析,mNGS结果为负.
- 在mNGS后对治疗变化的评估 (抗生素,皮质类固醇)
- 微生物群分析以识别与疾病严重程度标志物相关的细菌模式,如氧化指数和多溢液.
主要成果:
- 负的mNGS结果导致79.4%的患者停止使用抗生素.
- 70.7%的患者在阴性mNGS后开始或增加皮质类固醇治疗.
- 特定的细菌系 (Staphylococcus, Stenotrophomonas, Escherichia) 与较低的氧化指数和多流动有关.
结论:
- 在DPLD患者中,mNGS在优化抗生素和皮质类固醇治疗方面具有临床意义,对皮质类固醇有反应.
- 肺部微生物群的组成可以作为DPLD疾病严重程度的指标.
- 负的mNGS结果促进了抗生素的降级和皮质类固醇的升级.
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