宏基因组二代测序在初始治疗无反应性肺部感染患者中的应用  

Application of metagenome next-generation sequencing in the patients with anergic pulmonary infection after initial treatment

作　　者：宋晓波[1] 盛春风 赵邦凤 SONG Xiaobo;SHENG Chunfeng;ZHAO Bangfeng(Department of Respiratory and Critical Care Medicine,the Central Hospital of Songjiang,Shanghai201600,China)

机构地区：[1]上海市松江区中心医院呼吸与危重症医学科,上海201600

出　　处：《中国医药导报》2023年第10期152-155,共4页China Medical Herald

基　　金：上海市卫生和计划生育委员会面上项目(201640186)。

摘　　要：目的探讨宏基因组二代测序(mNGS)在初始治疗无反应性肺部感染患者中的应用。方法回顾性分析于2021年1月至2022年2月就诊上海市松江区中心医院呼吸与危重症医学科的初始治疗无反应性肺部感染患者50例,分别进行痰液、支气管肺泡灌洗液(BALF)的常规微生物培养,同时进行BALF的mNGS检测。观察病原微生物的分布情况,并比较传统检测方法与mNGS检测方法对初始治疗无反应性肺部感染微生物检测的差异。结果在50例初始治疗无反应性肺部感染患者中,常规痰培养阳性者2例,常规BALF培养阳性者4例,BALF mNGS检测阳性者44例。BALF mNGS微生物检测阳性率高于常规痰培养和常规BALF培养,差异有统计学意义(P<0.05)。常规痰培养和常规BALF培养微生物检测阳性率比较,差异无统计学意义(P>0.05)。27例患者根据mNGS检测结果调整抗生素后病情好转。在mNGS检出的微生物中最常见为细菌感染,以肺炎链球菌、流感嗜血杆菌、肺炎克雷伯菌、铜绿假单胞菌为主。结论mNGS应用于初始治疗无反应性肺部感染患者具有较高的微生物检测阳性率,可为临床调整治疗方案提供较强的参考依据。Objective To explore the application of metagenome next-generation sequencing(mNGS)in the patients with anergic pulmonary infection after initial treatment.Methods Fifty patients with anergic pulmonary infection after initial treatment admitted to the Department of Respiratory and Critical Care Medicine,the Central Hospital of Songjiang,Shanghai from January 2021 to February 2022 were retrospectively analyzed.Conventional microbial culture of sputum and bronchoalveolar lavage fluid(BALF)were performed,and mNGS of BALF were detected.The distribution of pathogenic microorganisms was observed,and the differences between the traditional detection method and the mNGS detection method in the microbial detection of anergic pulmonary infection after initial treatment were compared.Results Among the 50 patients with anergic pulmonary infection after initial treatment,two cases were positive for sputum culture,four case were positive for BALF culture,and 44 cases were positive for BALF mNGS.The positive rate of microbial detection of BALF mNGS was higher than those of conventional sputum culture and BALF culture,and the differences were statistically significant(P<0.05).There was no significant difference in the positive rate of microbial detection between conventional sputum culture and BALF culture(P>0.05).Twenty-seven patients improved after adjusting antibiotics according to the results of mNGS detection.The most common microorganisms detected in mNGS were bacterial infections,mainly Streptococcus pneumoniae,Haemophilus influenzae,Klebsiella pneumoniae,and Pseudomonas aeruginosa.Conclusion The application of mNGS in the patients with anergic pulmonary infection after initial treatment has a higher positive rate of microbial detection,which can provide a strong reference for clinical adjustment of treatment plan.

关 键 词：宏基因组二代测序 支气管肺泡灌洗液 微生物检测 肺部感染 

分 类 号：R563.1[医药卫生—呼吸系统]