宏基因组的二代测序技术在初治失败社区获得性肺炎患者病原菌检测中的应用价值  

Application value of metagenomic next-generation sequencing in detection of pathogens in patients with community-acquired pneumonia after initial treatment failure

作　　者：林明珍 赵磊 LIN Ming-zhen;ZHAO Lei(Department of Respiratory and Critical Care Medicine,the Fourth Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230022,China)

机构地区：[1]安徽医科大学第四附属医院呼吸与危重症学科,安徽合肥230022

出　　处：《临床肺科杂志》2021年第8期1180-1184,共5页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨基于宏基因组的二代测序技术(mNGS)在初治失败社区获得性肺炎(CAP)患者病原菌检测中的应用价值。方法回顾分析2019年5月1日至2020年12月31日安徽医科大学第四附属医院呼吸与危重症医学科收治初治失败CAP患者87例,统计其病原菌分布情况,并比较mNGS与传统检测方法对初治失败CAP病原菌诊断差异。结果87例初治失败CAP患者中,非重症CAP患者75例,重症CAP患者12例。在75例非重症CAP患者分离到的31种微生物中,细菌感染最常见,其次为结核,再次为真菌、病毒;在12例重症CAP患者分离到的14种微生物中,真菌感染最常见,其次为非典型病原体。mNGS检测出病原菌的阳性率为(85.06%),高于传统检测方法(8.04%)。差异有统计学意义(P<0.05)。结论mNGS对病原菌鉴定具有较高的灵敏度,为初治失败CAP患者提供了快速准确的病原菌检测方法,有助于更早识别病原体和指导用药,提高临床诊治水平。Objective To investigate the value of metagenomic next-generation sequencing(mNGS)in the detection of pathogens in patients with community-acquired pneumonia(CAP)after initial treatment failure.Methods The clnical data of 87 patients with CAP who failed initial treatment in the Department of respiratory and Critical Care Medicine of the Fourth Affiliated Hospital of Anhui Medical University from May 1st,2019 to December 31st,2020 were analyzed retrospectively,and the difference between mNGS and traditional methods(pathogen culture)in the diagnosis of CAP pathogen was compared.Results Among the 87 CAP patients who failed initial treatment,there were 75 non-severe CAP patients and 12 severe CAP patients.For 55 patients with non-severe CAP,31 microbial species were isolated,bacterial infection was the most common,followed by Mycobacterium tuberculosis,fungi and viruses.Of the 14 microorganisms isolated from 12 patients with severe CAP,fungal infection was the most common,followed by atypical pathogen.The positive rate of pathogenic bacteria detection by mNGS was 85.06%,which was higher than that by traditional detection method(8.04%)(P<0.05).Conclusion mNGS has a high sensitivity for pathogen identification,which can provide a rapid and accurate method for pathogen detection in CAP patients with initial treatment failure.

关 键 词：宏基因组的二代测序 初治失败 社区获得性肺炎 病原体 

分 类 号：R563.1[医药卫生—呼吸系统] R446.5[医药卫生—内科学]