支气管肺泡灌洗液基因芯片法病原体检测对难治性肺炎患儿的病原学诊断意义  

The value of bronchoalveolar lavage fluid genechip analysis for the identification of pathogens in children with refractory pneumonia

作　　者：杨家武[1] 赵亮 刘海沣 李银 李峰[1] 袁廷运 付红敏[1] Yang Jiawu;Zhao Liang;Liu Haifeng;Li Yin;Li Feng;Yuan Tingyun;Fu Hongmin(Department of Respiratory and Critical Care Medicine,Kunming Children′s Hospital,Kunming Medical University,Kunming 650031,China)

机构地区：[1]昆明医科大学附属昆明市儿童医院呼吸与危重症医学科,昆明650031

出　　处：《中华实用儿科临床杂志》2023年第4期281-285,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：昆明市卫生科技人才培养项目暨"十百千"工程(2020-SW(后备)-106)。

摘　　要：目的探讨支气管肺泡灌洗液(BALF)基因芯片法检测对难治性肺炎患儿病原学诊断的意义。方法回顾性研究。收集2020年1月至2022年1月昆明医科大学附属昆明市儿童医院呼吸与危重症医学科诊断为难治性肺炎的500例患儿资料,住院期间行支气管镜检查及支气管肺泡灌洗治疗,取BALF行基因芯片法病原体检测,同时完善痰液、BALF细菌培养。采用χ^(2)检验比较不同检测法的病原检出阳性率。结果BALF基因芯片法病原体检测的阳性患儿482例(96.4%),仅单一病原体感染患儿71例(14.7%),另411例(85.3%)检出2种及2种以上病原体。其中,居前3位的细菌分别为:肺炎链球菌117例次(8.3%),流感嗜血杆菌63例次(4.5%),百日咳杆菌32例次(2.3%)。居前3位的病毒分别为:呼吸道合胞病毒269例次(19.1%),副流感病毒217例次(15.4%),腺病毒132例次(9.3%)。BALF基因芯片法细菌检测阳性的患儿116例(23.2%),BALF细菌培养阳性的患儿47例(9.4%),痰培养的阳性患儿43例(8.6%),BALF基因芯片法细菌检测的阳性率最高,与BALF培养及痰培养阳性率比较,差异均有统计学意义(χ^(2)=34.90、39.85,均P<0.001)。结论难治性肺炎患儿大部分为混合感染,BALF基因芯片法病原学检测可快速、高效地获取病原学结果,为临床抗感染治疗提供用药指导。Objective To investigate the value of bronchoalveolar lavage fluid(BALF)genechip analysis for the identification of pathogens in children with refractory pneumonia.Methods A retrospective study of 500 children clinically diagnosed with refractory pneumonia in the Department of Respiratory and Critical Care Medicine,Kunming Children′s Hospital,Kunming Medical University between January 2020 to January 2022 was made.During hospitalization,bronchoscopic examination and bronchoalveolar lavage were performed.BALF was collected and analyzed using genechip technology to detect potential pathogens.At the same time,bacterial culture tests of sputum and BALF samples from the patients were performed.χ^(2) test was used to compare the positive rates of pathogens detected by different detection methods.Results Of the 500 children patients,482 cases(96.4%)were positive of BALF genechip analysis for pathogen identification.There were 71 cases(14.7%)infected with a single pathogen,and 411 cases(85.3%)with 2 or more pathogens.The top 3 bacteria were Streptococcus pneumoniae[117 cases(8.3%)],Haemophilus influenzae[63 cases(4.5%)],and Bordetella pertussis[32 cases(2.3%)].The patients were mostly infected with respiratory syncytial virus[269 cases(19.1%)],followed by parainfluenza virus[217 cases(15.4%)],and adenovirus[132 cases(9.3%)].Among the 500 patients,116 cases(23.2%)were positive of BALF genechip analysis for bacteria identification,47 cases(9.4%)had a positive BALF culture,43 cases(8.6%)had a positive sputum culture.The bacterial detection rate of BALF genechip analysis was statistically significantly higher than that of BALF culture and sputum culture tests(χ^(2)=34.90,39.85;all P<0.001).Conclusions Most patients with refractory pneumonia have mixed infections.The genechip technology can rapidly and efficiently identify the pathogens,thus providing clinical guidance for anti-infection treatment.

关 键 词：儿童 难治性肺炎 病原体 基因芯片法 

分 类 号：R725.6[医药卫生—儿科]