摘要目的:探讨二代测序技术在非人类免疫缺陷病毒（HIV）感染者肺孢子菌肺炎诊断中的应用价值。方法:回顾性分析解放军总医院第四医学中心2017年9月1日至2018年9月1日采用二代测序技术诊断的5例非HIV感染者肺孢子菌肺炎的诊治过程，并与常规实验室微生物检验结果进行比较，分析二代测序技术在非HIV感染者肺孢子菌肺炎诊断中的应用价值。结果:5例中男性3例，女性2例，平均年龄（48±6）岁。3例为膜性肾病，1例为结核性脑膜炎，1例为食管癌放化疗后，发病前均有糖皮质激素用药史。临床表现为发热、咳嗽、呼吸困难，胸部CT表现为双肺磨玻璃影，1， 3-β-D-葡聚糖试验结果均>1 000 ng/L。5例均行支气管肺泡灌洗，1例BALF六亚甲基四胺银染色发现肺孢子菌包囊，5例BALF二代测序均检出肺孢子菌和人类疱疹病毒核酸序列。5例均应用磺胺甲噁唑/甲氧苄啶治疗，中位治疗时间33（23，72） d，1.44 g，口服，1次/8 h；更昔洛韦治疗中位时间为15（6，22） d， 250 mg，静脉滴注，1次/12 h。经治疗后胸部CT表现及临床症状均好转，无死亡病例。结论:BALF的二代测序诊断非HIV患者肺孢子菌肺炎的特异度及敏感度高，较常规实验室检验方法更快速、全面、准确，可作为肺孢子菌肺炎诊断的方法之一。

abstractsObjective:To evaluate the clinical value of next-generation sequencing in the diagnosis of Pneumocystis pneumonia in non-HIV infected patients.Methods:A retrospective study was conducted on the diagnosis and treatment of Pneumocystis pneumonia in 5 non-HIV patients in the Fourth Medical Center of the General Hospital of the PLA from September 1, 2017 to September 1, 2018. Next-generation sequencing of BALF were compared with the traditional laboratory microbiological test, and the advantages of the next-generation sequencing in the diagnosis of Pneumocystis pneumonia in non-HIV infected patients were analyzed.Results:There were 3 males and 2 females, with a mean age (48±6) years. Three patients had membranous nephropathy, a patient had tuberculous meningitis, and a patient had esophageal cancer after radiotherapy and chemotherapy. All patients had glucocorticoid medication history before. The clinical manifestations were fever, cough and dyspnea. The chest CT mainly showed bilateral lung ground glass shadows. All the results of 1, 3-β-D-glucan test were more than 1 000 ng/L. Bronchoalveolar lavage was performed in the 5 cases, and Pneumocystis cysts were found in 1 BALF by Gomori′s methenamine silver nitrate staining, and the DNAs of Pneumocystis and human herpesvirus were detected in 5 BALFs by next-generation sequencing. All patients were treated with sulfamethoxazole/trimethoprim (orally, 1.44 g, q8 h) for 23 to 72 days (median 33 days), and with ganciclovir(Ⅳ, 250 mg q12 h) for 6 to 22 days (median 15 days). The chest CT manifestations and symptoms were improved after treatment, without death.Conclusions:The next-generation sequencing of BALF is more specific and sensitive in the diagnosis of Pneumocystis pneumoniae in non-HIV patients. It is faster, more comprehensive and more accurate than the traditional laboratory test, and could be widely used as a PCP diagnosis technique.