摘要
目的利用宏基因组新一代测序(mNGS)了解重症监护病房(ICU)中重症医院获得性肺炎(SHAP)患者的下呼吸道微生物群落结构。方法对84例SHAP患者的支气管肺泡灌洗液(BALF)进行宏基因组新一代测序(mNGS)。根据年龄、吸烟、基础疾病、人工气道时长进行分组,比较不同组别患者气道微生物的α多样性、β多样性、微生物组成和群落结构差异,筛选人工气道差异微生物,构建网络共现图观察微生物间的相互作用。结果α多样性分析显示,青年人的微生物群落多样性和均匀度显著高于中年人,合并脑卒中的微生物多样性和均匀度下降;人工气道治疗分组中,微生物的多样性和均匀度随人工气道治疗时长的增加而降低,人工气道治疗>3 d的多样性最低。β多样性分析显示,人工气道治疗>3 d的微生物群落结构与未行人工气道治疗组、人工气道治疗≤3 d组存在显著差异。下呼吸道微生物组成分析结果显示,鲍曼不动杆菌在所有组别中占据主导地位,中年组、非吸烟组、未行人工气道治疗组、无糖尿病组、人工气道治疗>3 d组和合并慢性肺部疾病组的菌群多样性较高,特别是铜绿假单胞菌、纹带棒杆菌、小韦荣球菌在这些组别中富集。差异分析显示人工气道治疗>3 d组和未行人工气道治疗组、人工气道治疗≤3 d组在铜绿假单胞菌和纹带棒杆菌存在显著差异。网络共现图显示部分微生物间可能存在协同作用或拮抗关系。结论SHAP患者的下呼吸道微生物多样性在老年人、合并脑卒中和接受人工气道治疗的人群中明显下降,这类人群应合理使用抗菌药物,指导精准抗感染治疗。
Objective To investigae microbial community structure of lower respiratory tract in severe hospital-acquired pneumonia(SHAP)patients in intensive care unit(ICU)using metagenomic next-generation sequencing(mNGS).Methods mNGS was performed on bronchoalveolar lavage fluid(BALF)of 84 patients with SHAP.Patients were grouped based on age,smoking status,underlying diseases and duration of artificial airway.The differences inαdiversity,βdiversity,microbial composition and community structure of airway microbiota were compared between different groups.The differential airway microbiota associated with artificial airway were screened,and microbial co-occurrence networks was constructed to observe the interaction in microorganisms.Results Results ofαdiversity analysis revealed that diversity and evenness of the microbial community were higher in young adults compared to those of middle-aged patients,while microbial diversity and evenness were significantly reduced in patients with comorbid stroke.In the group of artificial airway treatment,the diversity and uniformity of microorganisms decreased as the duration of artificial airway treatment increased.The diversity was the lowest when the artificial airway treatment lasted for more than 3 days.βdiversity analysis confirmed that there were significant differences in the distinct microbial community structures between the>3 days support group and the non-intubated and≤3 days support cohorts.Acinetobacter baumannii was dominant in all groups.The bacterial diversity was significantly higher in the middle-aged group,the non-smoking group,the group without artificial airway therapy,the group without diabetes mellitus,the group with artificial airway therapy≥3 days and the group with chronic lung disease than those of other groups.In particular,pseudomonas aeruginosa,corynebacterium striatum and veillonella parvula were enriched in these groups.Difference analysis showed that there were significant differences in pseudomonas aeruginosa and corynebacterium striatum between the group with artificial airway treatment>3 days,the group without artificial airway therapy and the group with artificial airway treatment≤3 days.Network co-occurrence showed that there may be synergistic or antagonistic relationships between some microorganisms.Conclusion The microbial diversity of the lower respiratory tract in patients with SHAP significantly decreases in the elderly,those with concurrent stroke and those receiving artificial airway treatment.For these groups,rational use of antibiotics should be adopted to guide precise anti-infection treatment.
作者
郑童童
王敏
单琦
李名航
柏亚真
富奇志
ZHENG Tongtong;WANG Min;SHAN Qi;LI Minghang;BAI Yazhen;FU Qizhi(Clinical Medical College of Henan University of Science and Technology,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471003,China;Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Henan University of Science and Technology;Department of Critical Care Medicine,the First Affiliated Hospital of Henan University of Science and Technology;Department of Neurology,Luoyang Central Hospital)
出处
《天津医药》
2025年第11期1145-1151,共7页
Tianjin Medical Journal
基金
河南省医学科技攻关计划省部共建青年项目(SBGJ202303042)。
关键词
肺炎
支气管肺泡灌洗液
微生物
宏基因组新一代测序
pneumonia
bronchoalveolar lavage fluid
microorganism
metagenomic next-generation sequencing
