肺泡灌洗液的高通量测序在肝移植后肺部感染的病原学诊断中的应用  

High-throughput sequencing of bronchoalveolar lavage fluid in pathogenic detection of pulmonary infection after liver transplantation

作　　者：王鑫[1] 栗光明 林栋栋[2] 刘晋宁[2] 何莉[1] Wang Xin;Li Guangming;Lin Dongdong;Liu Jingning;He Li(Surgical Intensive Care Unit,Beijing 100069,China;Center of General Surgery,Affiliated Beijing You'an Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院重症医学科,100069 [2]首都医科大学附属北京佑安医院普通外科中心,100069

出　　处：《中华器官移植杂志》2020年第8期492-495,共4页Chinese Journal of Organ Transplantation

基　　金：首都医科大学附属北京佑安医院2018年度院内课题中青年人才孵育项目(YNKTTS20180124);首都临床特色应用研究与成果推广2017(Z171100001017035)

摘　　要：目的评估对肺泡灌洗液进行高通量测序对于肝移植术后肺部感染的病原学诊断价值。方法以8例肝移植后怀疑肺部感染引起呼吸衰竭接受有创机械通气受者为研究对象,收集受者的肺泡灌洗液(BALF)及痰标本,对BALF进行高通量测序,同时对BALF及痰标本进行培养,对检测结果进行对比。结果8例受者中,确诊肺部感染5例,高通量测序共检出10种可疑病原微生物21株,确定致病菌8株,致病菌检出率为100%(8/8),显著高于BALF培养的50%(4/8)和痰培养的25%(2/8);对于致病的革兰阴性菌,高通量测序与BALF培养无明显差异,两者均优于痰培养;对于真菌、病毒及结核,高通量测序检出率明显优于BALF培养及痰培养。结论BALF的高通量测序可能优于传统培养,尤其是对于部分细菌、真菌、病毒等不易培养或不能培养的病原微生物,高通量测序优势明显,可作为肝移植术后肺部感染病原体检测的新方法。Objective To evaluate the diagnostic value of high-throughput sequencing of bronchoalveolar lavage fluid(BALF)in pathogenic detection of pulmonary infection after liver transplantation.Methods Eight patients with invasive mechanical ventilation post-transplantation and suspected pulmonary infection-induced respiratory failure were examined.BALF and sputum specimens were collected for high-throughput sequencing.Also BALF and sputum were cultured respectively.Results Pulmonary infection was confirmed in 5/8 patients.A total of 21 strains of 10 suspected pathogens were detected by high-throughput sequencing of BALF.And 8 strains of pathogenic pathogens were identified with a detection rate of causative pathogens at 100%(8/8).It was significantly higher than BALF culture 50%(4/8)and sputum culture 25%(2/8).For pathogenic gram-negative bacteria,no significant difference existed between high-throughput sequencing of BALF and its culture.Both were superior to sputum culture.For fungi,virus and tuberculosis,the detection rate of high-throughput sequencing of BALF was significantly superior to BALF/sputum culture.Conclusions High-throughput sequencing of BALF is superior to traditional culture,especially for some bacteria,fungi and viruses difficult for culturing.High-throughput sequencing of BALF may be employed as a novel method of detecting pathogens of pulmonary infection after liver transplantation.

关 键 词：高通量测序 肺泡灌洗液 肝移植 肺部感染 

分 类 号：R657.3[医药卫生—外科学] R563.1[医药卫生—临床医学]