摘要
目的比较严重急性呼吸道感染(SARI)患儿不同呼吸道标本的12种常见呼吸道病原体核酸检测结果的差异,为儿童SARI诊断提供指导。方法选取2023年8月至2024年8月在武汉市红十字会医院就诊的120例SARI患儿,采集患儿咽拭子、支气管肺泡灌洗液(BALF)和痰液标本,分别进行病原体核酸检测和宏基因组测序检测。比较不同标本对12种常见呼吸道病原体阳性检出率的差异,分析不同标本与金标准(宏基因组测序)结果的一致性。结果咽拭子非细菌性呼吸道病原体阳性检出率为30.00%,以甲型流感病毒(IFVA)、乙型流感病毒(IFVB)和呼吸道合胞病毒为主;痰液、痰液阳性检出率分别为50.83%、70.83%,均以IFVA、IFVB和肺炎支原体为主;3种标本非细菌性呼吸道病原体阳性检出率比较,痰液阳性检出率高于咽拭子,低于BALF,差异有统计学意义(χ^(2)=40.027,P<0.05)。咽拭子、痰液的细菌性呼吸道病原体阳性检出率分别为27.50%和47.50%,均以铜绿假单胞菌(PA)、肺炎链球菌(SP)和肺炎克雷伯杆菌为主;BALF阳性检出率为64.17%,以PA、SP和流感嗜血杆菌为主;3种标本细菌性呼吸道病原体阳性检出率比较,痰液阳性检出率高于咽拭子,低于BALF,差异有统计学意义(χ^(2)=35.525,P<0.05)。一致性分析显示,咽拭子病原体核酸检测与宏基因组测序结果的一致性差(非细菌性和细菌性Kappa值分别为0.110、0.158),痰液病原体核酸检测与宏基因组测序结果的一致性一般(Kappa值分别为0.328、0.314),BALF病原体核酸检测与宏基因组测序结果的一致性好(Kappa值分别为0.753、0.735)。结论在SARI患儿中,BALF标本呼吸道病原体核酸检测的阳性率高于痰液和咽拭子,且与宏基因组测序检测结果的一致性较好,有更高的临床应用价值。
Objective To analyze the differences in nucleic acid test results of 12 common respiratory pathogens across different respiratory specimens from children with severe acute respiratory infection(SARI),so as to provide guidance for diagnosing pediatric SARI.Methods A total of 120 children with SARI treated at Wuhan Red Cross Hospital from August 2023 to August 2024 were enrolled.Their throat swabs,sputum specimens and bronchoalveolar lavage fluid(BALF)were collected.Pathogen nucleic acid testing and metagenomic sequencing were performed separately.The differences in pathogen profiles and positive detection rates of pathogens among different specimens were analyzed.The consistency between different specimens and the gold standard(metagenomic sequencing results)was discussed.Results The positive detection rate of nonbacterial respiratory pathogens in throat swabs was 30.00%,and the detected pathogens mainly included influenza A virus(IFVA),influenza B virus(IFVB),and respiratory syncytial virus.The positive detection rate of nonbacterial respiratory pathogens in sputum and BALF specimens was 50.83%and 70.83%,respectively,and the detected pathogens mainly included IFVA,IFVB,and mycoplasma pneumoniae.The positive detection rates in sputum were higher than those in throat swabs and lower than those in BALF,with statistically significant differences(χ^(2)=40.027,P<0.05).The positive detection rates of bacterial respiratory pathogens in throat swabs and sputum specimens were 27.50%and 47.50%,respectively,which were dominated by pseudomonas aeruginosa(PA),streptococcus pneumoniae(SP),and Klebsiella pneumoniae.The positive detection rate of pathogens in BALF specimens was 64.17%,which were dominated by PA,SP,and haemophilus influenzae.The positive detection rates in sputum were higher than those in throat swabs and lower than those in BALF,with statistically significant differences(χ^(2)=35.525,P<0.05).Consistency analysis showed that the consistency between throat swab pathogen nucleic acid detection and metagenomic sequencing results was poor(Kappa values=0.110,0.158),the consistency between sputum pathogen nucleic acid detection and metagenomic sequencing results was average(Kappa values=0.328,0.314),and the consistency between BALF pathogen nucleic acid detection and metagenomic sequencing results was good(Kappa values=0.753,0.735).Conclusion For children with SARI,the positive detection rates of respiratory pathogens in BALF specimens are higher than those in sputum and throat swabs.BALF results show good consistency with metagenomic sequencing results,indicating that BALF specimens has higher clinical application value.
作者
胡鹏
毛佳颖
陈梦思
徐丽君
赵淦
HU Peng;MAO Jiaying;CHEN Mengsi;XU Lijun;ZHAO Gan(Department of Clinical Laboratory,Wuhan Red Cross Hospital,Wuhan Hubei 430015,China)
出处
《转化医学杂志》
2025年第5期13-18,共6页
Translational Medicine Journal
基金
武汉市红十字会医院科研项目(WHRCH202307)
科技部国家重点研发计划子课题项目(2022YFF0710300)。
关键词
严重急性呼吸道感染
儿童
病原体
病原菌
Acute respiratory tract infection
Child
Pathogen
Pathogenic bacteria
