宏基因组二代测序在肺部感染合并呼吸衰竭中的应用  

Application of Metagenomic Next-Generation Sequencing in Pulmonary Infection Complicated with Respiratory Failure

作　　者：张莹莹[1] 刘斌[1] ZHANG Yingying;LIU Bin(Deparment of Respiratory and Critical Care Medicine,Fuyang People’s Hospital,Fuyang City,Anhui Province 236011)

机构地区：[1]安徽医科大学附属阜阳人民医院呼吸与危重症医学,安徽省阜阳市236011

出　　处：《医学理论与实践》2023年第22期3787-3790,共4页The Journal of Medical Theory and Practice

基　　金：安徽省临床医学研究转化专项(202204295107020014)。

摘　　要：目的:研究宏基因组二代测序(mNGS)在肺部感染合并呼吸衰竭患者中的微生物分布、病原学诊断及对临床诊疗策略等方面的应用价值。方法:收集肺部感染合并呼吸衰竭的89例患者的临床资料,每位患者同时行mNGS检测与传统培养。通过对入选患者的一般临床资料、传统病原学检测结果及mNGS检测结果实施回顾性分析。结果:(1)89例样本中,mNGS检测的阳性率为93.26%,传统微生物检测的阳性率为69.66%,两者的差异有显著统计学意义(P<0.01)。(2)同时行mNGS与传统病原学培养(真菌+细菌培养)患者81例,mNGS检测阳性率为86.52%,传统病原学培养检测阳性率64.04%,两者的差异有显著统计学意义(P<0.01)。(3)同时行mNGS与PCR检测共64例,PCR阳性为48.44%,mNGS阳性率为90.63%,经检验两者差异有显著统计学意义(P<0.05)。(4)mNGS与传统病原学检测灵敏度具有显著统计学差异(P<0.05),特异度无统计学差异(P>0.05)。(5)发展为重症肺炎的患者感染类型中单纯感染、混合感染较未发展为重症肺炎患者有统计学差异(P<0.05)。(6)调整抗生素治疗方案有48例,重症组24例,非重症组20例。两组的好转率差异有统计学意义(P<0.05),病死率差异无统计学意义(P=0.81)。结论:mNGS在肺部感染合并呼吸衰竭患者中,诊断效能较传统方法高,对临床诊疗指导有重要意义。Objective:To study the application value of metagenomic next generation sequencing(mNGS)in microbial distribution,etiological diagnosis and clinical diagnosis and treatment strategy in patients with pulmonary infection complicated with respiratory failure.Methods:The clinical data of 89 patients with pulmonary infection and respiratory failure were collected.Each patient underwent mNGS detection and traditional culture at the same time.The general clinical data,results of traditional pathogen detection and mNGS test of the selected patients were retrospectively analyzed.Results:(1)Among the 89 samples,the positive rate of mNGS detection was 93.26%,and the positive rate of conventional microbiological detection was 69.66%,and the difference was statistically significant(P<0.01).(2)There were 81 patients with both mNGS and traditional pathogen culture(fungal+bacterial culture),the positive rate of mNGS was 86.52%,and the positive rate of traditional pathogen culture was 64.04%,the difference between the them was statistically significant(P<0.01).(3)A total of 64 cases were simultaneously tested by mNGS and PCR,the positive rate of PCR was 48.44%,the positive rate of mNGS was 90.63%,the difference was statistically significant(P<0.05).(4)The sensitivity of mNGS was significantly different from that of traditional pathogen detection(P<0.05),but there was no significant difference in specificity(P>0.05).(5)The infection types of patients who developed into severe pneumonia were simple infection,mixed infection,and mixed infection,which were statistically different from those of patients who did not develop into severe pneumonia(P<0.05).(6)The antibiotic treatment was adjusted in 48 cases,including 24 cases in severe group and 20 cases in non-severe group.There was a significant difference in the improvement rate between the two groups(P<0.05),but there was no significant difference in the mortality rate(P=0.81).Conclusion:The diagnostic efficiency of mNGS in patients with pulmonary infection complicated with respirato

关 键 词：宏基因组二代测序 呼吸衰竭 肺部感染 

分 类 号：R446[医药卫生—诊断学]