二代测序技术在重症社区获得性肺炎诊断中的意义  

Diagnostic value of next-generation sequencing in severe community-acquired pneumonia

作　　者：陈涔 李园园[1] 潘频华[1] 胡成平[1] 杨华平[1] CHEN Cen;LI Yuan-yuan;PAN Pin-hua;HU Cheng-ping;YANG Hua-ping(Department of Respiratory Medicine,Core Unit of National Clinical Reaserch Center for Respiratory Disease,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院呼吸内科呼吸与危重症医学科国家临床重点专科国家呼吸疾病临床医学研究中心核心单位,湖南长沙410008

出　　处：《中国感染控制杂志》2020年第4期335-340,共6页Chinese Journal of Infection Control

基　　金：国家重点研发计划(2018YFC1311900);国家自然科学基金青年科学基金项目(81600025)。

摘　　要：目的探讨基于宏基因组学的二代测序(mNGS)技术在重症社区获得性肺炎(CAP)病原学诊断中的意义,为合理应用该技术提供依据。方法回顾某单位成功救治的3例重症CAP患者临床资料,分析mNGS在其病原学诊断中的作用,结合文献和自身经验,总结合理应用该技术的经验和步骤。结果 3例初始治疗失败的急危重症CAP患者留取其支气管肺泡灌洗液行mNGS,结果提示3例患者分别为链球菌、腺病毒7型、鹦鹉热衣原体感染。依据mNGS结果相应调整治疗方案,患者症状迅速改善,治疗效果确切,预后好。结论 mNGS技术在重症CAP的病原学快速诊断中具有重要意义,但同时也要正确认识其局限性,做到合理应用。Objective To explore the diagnostic value of metagenomic next-generation sequencing(mNGS) in severe community-acquired pneumonia(CAP), and provide basis for the rational application of this technology.Methods Clinical data of 3 cases of severe CAP successfully treated in a hospital were reviewed, the role of mNGS in etiological diagnosis was analyzed, experience and procedures of rational application of mNGS were summarized based on previous literatures and self-experience.Results Bronchoalveolar lavage fluid was taken from 3 patients with severe CAP who failed in initial treatment, specimens were performed mNGS, results indicated that 3 patients were infected with Streptococcus, adenovirus type 7 and Chlamydia psittaci respectively. According to the results of mNGS, therapeutic plan was subsequently adjusted, patients’ symptoms quickly relieved, and their clinical outcomes were good. Conclusion mNGS plays an important role in the rapid etiological diagnosis of severe CAP, but it is also necessary to recognize its limitation and make rational application.

关 键 词：二代测序 重症肺炎 诊断 合理应用 

分 类 号：R563.1[医药卫生—呼吸系统]