摘要
目的:应用宏基因二代测序(mNGS)检测不明原因肺部感染患者肺泡灌洗液中病原体,探讨其诊断复杂肺部感染病原体的临床应用价值。方法:回顾分析2020年8月~2021年8月皖南医学院第二附属医院收治的不明病原体肺部感染患者30例,行传统病原体检测(痰涂片、痰培养、肺泡灌洗液培养)及收集肺泡灌洗液标本行mNGS检测病原体。比较肺泡灌洗液mNGS检测与传统病原体检测的阳性率、病原体的分布;比较肺泡灌洗液mNGS检测结果指导用药和经验性治疗疗效。结果:30例不明病原体肺部感染患者中,传统病原体检测(痰涂片、痰培养、肺泡灌洗液培养)阳性患者6例,阳性率20.0%。肺泡灌洗液mNGS检测阳性患者25例,阳性率83.3%。肺泡灌洗液mNGS检测阳性率高于传统病原体检测,差异有统计学意义(P<0.05)。肺泡灌洗液mNGS对分枝杆菌、真菌及机会感染病原体的检出高于传统病原体检测。肺泡灌洗液mNGS测定的病原体选用针对性药物治疗疗效优于经验性药物治疗,差异有统计学意义(P<0.05)。结论:肺泡灌洗液mNGS检测能提高不明病原体肺部感染病原体检出率,尤其对分枝杆菌、真菌及机会感染病原体检出高,从而指导抗微生物药物的精准治疗,提升治疗效果。肺泡灌洗液mNGS检测在肺部感染中有非常高的临床应用价值。
Objective:To evaluate the diagnostic value of metagenomic next-generation sequencing(mNGS) of bronchoalveolar lavage fluid(BALF) in detecting the unknown pathogens in pulmonary infection.Methods:Retrospective analysis was performed in 30 cases of unknown pathogen induced pulmonary infection treated in our hospital between August 2020 and August 2021.All patients underwent mNGS of BALF and conventional pathogen detection(including sputum smear, the lavage fluid and sputum culture).Comparison was made pertinent to the positive rate and the pathogen distribution detected by the two methods as well as the outcomes of medication guided by the results of mNGS and empirical treatment.Results:In the 30 patients with pulmonary infection caused by unknown pathogens, conventional pathogen detection(including sputum smear, the lavage fluid and sputum culture) indicated positive findings in 6(20%),and mNGS revealed positive results in 25(83.3%),with significant difference(P<0.05).nNGS of BALF was more competent in detecting mycobacteria, fungi and pathogens than conventional pathogen studies, and the therapeutic effect was better in target opportunistic pathogens than conventional pathogen studies, and the therapeutic effect was better in target medication in compliance with mNGS findings than by empirical drugs.The difference was significant(P<0.05).Conclusion:mNGS of BALF is clinically valuable in diagnosis of pulmonary infection, because it can not only better detect the unknown pathogen, especially mycobacteria, fungi and opportunistic pathogens, in patients with pulmonary infection, but also improve precise treatment using antimicrobial drugs as well as treatment effect.
作者
夏勇惠
高秀峰
王慧
黄友明
XIA Yonghui;GAO Xiufeng;WANG Hui;HUANG Youming(Department of Respiratory and Critical Care Medicine,The Second Affiliated Hospital of Wannan Medical College,Wuhu 241000,China)
出处
《皖南医学院学报》
CAS
2022年第4期337-340,共4页
Journal of Wannan Medical College
基金
皖南医学院中青年科研基金项目(WK2018F41,WK2018F43)。
关键词
病原体
肺部感染
宏基因二代测序
肺泡灌洗液
pathogen
pulmonary infection
metagenomic next-generation sequencing
bronchoalveolar lavage fluid
