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目的:探讨宏基因组二代测序(mNGS)在间质性肺病(ILD)伴肺部感染患者中的初步应用。方法:本研究为病例对照研究。采用单纯随机抽样法，选取2018年1月至2019年8月南京大学医学院附属鼓楼医院呼吸与危重症医学科住院、诊断为ILD伴感染患者61例为研究对象。按照是否进行mNGS检测，分为mNGS组(n n＝18)和对照组(n n＝43)。收集研究对象的临床、实验室及胸部影像学资料，并进行电话随访。比较2组患者的临床资料，比较mNGS检测与传统病原微生物培养的差异。采用Kaplan-Meier法及Cox回归模型分析患者生存情况及预后因素。n 结果:2组患者比较，除了mNGS组住院时间较对照组明显延长(n P＝0.001)，其他临床变量间差异均无统计学意义(n P值均>0.05)。mNGS组检测结果与临床综合判断结果符合率为83.3%，传统实验室培养结果与临床综合判断结果符合率为33.3%，差异有统计学意义(n P＝0.008)。有50.0%(9/18)的患者根据mNGS检测结果调整治疗方案，44.4%(8/18)的患者经调整治疗后病情好转。Kaplan-Meier生存分析显示mNGS组患者总生存时间较对照组显著延长，差异有统计学意义(n P＝0.031)，其中mNGS组患者30 d、180 d、360 d生存率明显高于对照组(n P值均<0.05)。单因素Cox回归分析发现外周血白细胞计数、C反应蛋白、降钙素原、血清白蛋白、乳酸脱氢酶、氧合指数、丙种球蛋白使用、mNGS检测均与ILD伴感染患者生存时间有关(n P值均<0.05)；多因素Cox回归分析显示血清乳酸脱氢酶水平(n HR＝1.01，95% n CI：1.00~1.01，n P＝0.001)和mNGS检测(n HR＝0.12，95% n CI：0.02~0.98，n P＝0.048)是ILD伴感染患者生存的独立预测因素。n 结论:mNGS检测可以及时准确地明确ILD伴感染患者致病原，指导临床医师合理进行抗感染治疗，从而提高患者的生存率，改善患者预后。“,”Objective:To explore the application value of metagenomic next generation sequencing (mNGS) in interstitial lung disease (ILD) patients with pulmonary infection.Methods:This was a case-control study.Using the method of simple random sampling, 61 patients with ILD and infection were selected from the Department of Respiratory and Critical Medicine of Gulou Hospital Affiliated to Medical College of Nanjing University from January 2018 to August 2019.According to whether mngs was detected or not, they were divided into mngs group (n n=18) and control group (n n=43). The clinical, laboratory and chest imaging data of the subjects were collected and the patients were followed up by telephone.After analyzing the baseline clinical data of the two groups, we compared the differences between mNGS detection and conventional pathogenic microbial culture.The Kaplan-Meier method and Cox regression model were used to analyze the survival and prognostic factors.n Results:There were no significant differences in baseline clinical characteristics and treatment between the two groups except for the longer hospital stay in the mNGS group compared with the control group (n P=0.001). The compliance rate between the test results and clinical judgment was 83.3% in the mNGS group and 33.3% in the conventional laboratory culture, with significant difference (n P=0.008). Half of the cases (9/18) changed treatment based on the results of mNGS, and 8/18 patients (44.4%) were improved after adjusted treatment.Kaplan-Meier survival analysis showed that the the overall survival time of patients in the mNGS group was significantly longer than that in the control group, with statistically significant difference (n P=0.031). The survival rates of 30, 180 and 360 days in mNGS group were significantly higher than those in control group (all n P<0.05). Univariate Cox regression analysis revealed that WBC, CRP, procalcitonin, serum albumin, lactate dehydrogenase, oxygenation index, gamma globulin use, and mNGS were all associated with survival time in patients with ILD with infection (alln P<0.05); multifactorial Cox regression analysis showed that serum lactate dehydrogenase level (n HR=1.01, 95%n CI: 1.00-1.01, n P=0.001) and mNGS (n HR=0.12, 95% n CI: 0.02-0.98, n P=0.048) were independent predictors of survival in patients with ILD with infection.n Conclusions:mNGS can clarify the causative agent of ILD with infection in a timely and accurate manner and guide clinicians to carry out anti-infection treatment reasonably, thus increasing the survival rate and improving the prognosis of patients.