摘要
目的探讨荧光染色真菌形态学快速现场评价(ROSE)分析在侵袭性肺部真菌感染中的床旁快速诊断价值。方法本研究为观察性研究。采用随机抽样法选取2022年3月1日至2023年8月31日就诊于河北医科大学第二医院可疑为肺部真菌感染的患者150例,行支气管肺泡灌洗,灌洗液送检荧光染色真菌形态学ROSE分析,实验室检测革兰染色同时接种沙保罗琼脂培养基,以及宏基因组二代测序(mNGS),评价3种检测方法对真菌鉴定的临床意义。以临床诊断为侵袭性肺部真菌感染为标准,计算3种方法的诊断阳性率和差异性。结果临床诊断为侵袭性肺部真菌感染15例,阳性率为10.00%(15/150)。荧光染色真菌形态学ROSE分析阳性率为23.33%(35/150),mNGS检测阳性率为26.00%(39/150),实验室检查阳性率为7.33%(11/150)。荧光染色真菌形态学ROSE分析、mNGS检测与临床诊断阳性之间的差异有统计学意义(均P<0.001),实验室检查与临床诊断阳性之间的差异无统计学意义(P>0.05)。在菌属鉴定方面,荧光染色真菌形态学ROSE分析的结果较贴近临床诊断。结论荧光染色真菌形态学ROSE分析较常规实验室检查阳性率高、菌属鉴定类型全面,可减少临床漏诊,较mNGS快捷、经济,值得进一步探讨、推广,为侵袭性肺部真菌感染的床旁快速诊断开拓新思路。
ObjectiveTo investigate the value of a rapid on-site evaluation(ROSE)of the fluorescence staining fungal morphological analysis in the diagnosis of invasive pulmonary fungal diseases.MethodsThis was an observational study involving 150 randomly sampled patients suspected of pulmonary fungal infections who visited the Second Hospital of Hebei Medical University from March 1,2022 to August 31,2023.Bronchoalveolar lavage was performed.The bronchoalveolar lavage fluid was collected and sent for fluorescence staining for ROSE of fungal morphology,laboratory testing for Gram staining plus Sabouraud agar inoculation,and metagenomic next-generation sequencing(mNGS)to evaluate the clinical significance of three detection methods for fungal identification.Taking the clinical diagnosis of invasive pulmonary fungal infection as the criterion,the positive diagnostic rate and difference of the three methods were calculated.ResultThere were 15 cases with a clinical diagnosis of invasive pulmonary fungal infection,with the positive rate of 10.00%(15/150).The positive rate of ROSE analysis,mNGS,and laboratory examination was 23.33%(35/150),26.00%(39/150),and 7.33%(11/150),respectively.There was a significant difference in the positive detection rate between the ROSE analysis versus clinical diagnosis,and between mNGS versus clinical diagnosis(both P<0.001),while the difference between laboratory examination and clinical diagnosis was not statistically significant(P>0.05).In terms of bacterial genus identification,the results of the ROSE analysis of fungal morphology by fluorescence staining were relatively close to the clinical diagnosis.ConclusionThe ROSE analysis of fungal morphology by fluorescent staining has a higher positive rate than laboratory test in clinical application,and the types of bacterial genus identification are comprehensive,which can reduce clinical missed diagnoses.Compared with mNGS,it is faster and more economical.It is worthy of further exploration and promotion,and opens up new ideas for the diagnosis of invasive pulmonary fungal diseases.
作者
任雪珠
晁灵善
阎锡新
Ren Xuezhu;Chao Lingshan;Yan Xixin(First Department of Respiratory and Critical Care Medicine,the Second Hospital of Hebei Medical University,Hebei Institute of Respiratory Diseases,Hebei Key Laboratory of Respiratory Critical Care Medicine,Shijiazhuang 050000,China)
出处
《国际呼吸杂志》
2025年第5期411-416,共6页
International Journal of Respiration
基金
河北省省级科技计划(22377714D)
2020年度河北省医学科学研究课题计划(20200060)。
关键词
肺疾病
真菌性
快速现场评价
实验室检查
宏基因组二代测序
Lung diseases,fungal
Rapid on-site evaluation
Laboratory examination
Metagenomic next-generation sequencing
