宏基因二代测序技术在无反应肺炎诊治中的应用价值  

Application value of metagenomics next-generation sequencing in the diagnosis and treatment of unresponsive pneumonia

作　　者：张安兵[1] 袁小玲[1] 夏秀琼[1] 吕燕华[1] 张丹丹 梁剑平[1] ZHANG An-bing;YUAN Xiao-ling;XIA Xiu-qiong;LV Yan-hua;ZHANG Dan-dan;LIANG Jian-ping(Department of Respiratory and Critical Care Medicine,Zhongshan People's Hospital,Zhongshan 528400,Guangdong,CHINA)

机构地区：[1]中山市人民医院呼吸与危重症医学科,广东中山528400

出　　处：《海南医学》2022年第10期1266-1269,共4页Hainan Medical Journal

基　　金：广东省医学科学技术研究基金(编号:C2019032);广东省中山市医学科研项目(编号:2021J096)。

摘　　要：目的探讨宏基因二代测序(mNGS)技术在无反应肺炎诊治中的应用价值。方法选取中山市人民医院2019年1月至2021年5月收治的60例无反应肺炎患者,采用随机数表法分为实验组和对照组各30例。对照组患者给予经验性抗感染治疗,根据痰涂片、痰培养、化验结果调整治疗方案;实验组患者经纤支镜行肺泡灌洗术,将灌洗液行mNGS检测,根据mNGS结果调整治疗方案。治疗结束后比较两组患者的病原体检出率、临床疗效、抗菌药物使用时间、平均住院日、平均住院费用和28 d死亡率。结果实验组患者的病原体检出率为90.00%,明显高于对照组的43.33%,差异有统计学意义(P<0.05);治疗20 d后实验组患者的治疗总有效率为86.67%,明显高于对照组的63.33%,差异有统计学意义(P<0.05);实验组患者的抗菌药物使用时间、平均住院日、平均住院费用明显短(低)于对照组,差异均有统计学意义(P<0.05);28 d内实验组无患者死亡,对照组1例患者死亡,两组患者28 d死亡率比较差异无统计学意义(P>0.05)。结论mNGS应用于无反应肺炎患者能明显提高病原体检测阳性率和治疗效果,缩短抗生素使用时间及住院时间,降低住院费用,值得临床推广使用。Objective To explore the application value of metagenomics next-generation sequencing(mNGS)in the diagnosis and treatment of unresponsive pneumonia.Methods Sixty patients with unresponsive pneumonia treated in Zhongshan People's Hospital from January 2019 to May 2021 were randomly divided into an experimental group and a control group,with 30 patients in each group.The patients in the control group were given empirical anti-infection treatment,and the treatment plan was adjusted according to the results of sputum smear,sputum culture and laboratory test.The patients in the experimental group underwent alveolar lavage under fiberoptic bronchoscope,the lavage fluid was detected by mNGS,and the treatment scheme was adjusted according to the results of mNGS.After treatment,the detection rate of pathogen,clinical efficacy,use time of antibiotics,average length of hospital stay,average hospitalization expenses,and 28-day mortality of the two groups were compared.Results The detection rate of pathogens in the experimental group was 90.00%,which was significantly higher than 43.33%in the control group(P<0.05).After 20 days of treatment,the effective rate of the experimental group was 86.67%,which was significantly higher than 63.33%of the control group(P<0.05).The use time of antibiotics,average length of hospital stay,and average hospitalization expenses in the experimental group were significantly shorter or lower than those in the control group(P<0.05).No patient died in the experimental group within 28 days and one patient died in the control group.There was no significant difference in 28-day mortality between the two groups(P>0.05).Conclusion The application of mNGS in patients with unresponsive pneumonia can significantly improve the positive rate of pathogen detection and treatment effect,shorten the use time of antibiotics,and reduce the length of hospital stay and hospitalization expenses.It is worthy of clinical promotion.

关 键 词：无反应肺炎 宏基因二代测序 病原体 诊断 治疗 

分 类 号：R563.1[医药卫生—呼吸系统]