基于Illumina平台mNGS技术在老年社区获得性肺炎肺泡灌洗液病原学诊断中的应用  

Application of mNGS technology based on Illumina platform in the pathogenic diagnosis of elderly community acquired pneumonia alveolar lavage fluid

作　　者：李兴明[1] 谢秀芳[1] 王宪刚[1] 李云[1] 罗进[1] 何珍 邓魏岚 胡晓菁 LI Xingming;XIE Xiufang;WANG Xiangang;LI Yun;LUO Jin;HE Zhen;DENG Weilan;HU Xiaojing(Department of Respiratory and Critical Care Medicine,the First Peoples Hospital of Neijiang City,Neiji-ang,Sichuan,China,641000)

机构地区：[1]内江市第一人民医院呼吸与危重症医学科,四川内江641000

出　　处：《分子诊断与治疗杂志》2023年第11期1965-1968,共4页Journal of Molecular Diagnostics and Therapy

基　　金：四川省医学青年创新科研课题计划(Q21050)。

摘　　要：目的 探讨基于Illumina平台宏基因组二代测序(mNGS)技术在老年社区获得性肺炎(CAP)肺泡灌洗液病原学检查中的应用。方法 选取2022年1月至2022年6月内江第一人民医院收治的疑诊老年CAP患者200例为研究对象,比较肺泡灌洗液mNGS病原体检测与传统细菌培养鉴定法对老年CAP的诊断价值。结果 200例患者经病原学检查共检出阳性154例(77.00%),其中细菌感染119例(59.50%)、病毒感染59例(29.50%)、真菌感染30例(15.00%)、肺炎支原体感染11例(5.50%)、肺炎衣原体感染7例(3.50%),包含混合感染50例(25.00%);mNGS共检出阳性183例(91.5%),其中细菌感染127例(63.50%)、病毒感染96例(48.00%)、真菌感染37例(18.50%)、肺炎支原体感染29例(14.50%)、肺炎衣原体感染15例(750%),包含混合感染75例(37.50%);mNGS阳性检出率、混合感染检测率较传统细菌培养高,差异有统计学意义(χ^(2)=15.845、7.723,P<0.05);mNGS检测时间较传统细菌培养鉴定短,差异有统计学意义(t=86.888,P<0.05);以临床诊断为金标准,mNGS诊断老年CAP的灵敏度、特异度为97.31%、85.71%,传统细菌培养灵敏度、特异度为71.43%、80.64%。结论 基于Illumina平台mNGS对病原体具有较高的检出率,检测时间更短,检测灵敏度、特异度更好,可以为老年CAP临床诊断提供重要依据。Objective To explore the application of Illumina-based metagenomic second-genera-tion sequencing(mNGS)technology in the etiological examination of alveolar lavage fluid in elderly communi-ty-acquired pneumonia(CAP).Methods A total of 200 elderly patients whose suspected diagnosis were CAP and admitted to Neijiang First Peoples Hospital from January 2022 to June 2022 were selected as the re-search objects to compare the diagnostic value of mNGS in the pathogen detection in pulmonary alveolar la-vage fluid with traditional bacterial culture identification in elderly patients with CAP.Results A total of 154(77.00%)of the 200 patients were positive by etiological examination,including 119(59.50%)bacterial in-fection,59(29.50%)viral infection,30(15.00%)fungal infection,11(5.50%)mycoplasma pneumoniae in-fection and 7(3.50%)chlamydia pneumoniae infection.There were 50 cases of mixed infection(25.00%).A total of 183 cases(91.5%)were positive using mNGS,including 127 cases(63.50%)of bacterial infection,96 cases(48.00%)of viral infection,37 cases(18.50%)of fungal infection,29 cases(14.50%)of mycoplas-ma pneumoniae infection and 15 cases(750%)of chlamydia pneumoniae infection.71 cases(35.50%)were mixed infection.The positive and mixed infection detection rates of mNGS were higher than those of tradition-al bacterial culture(X^(2)=15.845,7.723,P<0.05).The detection time of mNGS was shorter than that of tradi-tional bacterial culture(t=86.888,P<0.05).With the clinical diagnosis as the gold standard,the sensitivity and specificity of mNGS in the diagnosis of CAP in the aged were 97.31%and 85.71%,and the sensitivity and specificity of traditional bacterial culture were 71.43%and 80.64%.Conclusion Illumina-based mNGS has a higher detection rate of pathogens,shorter detection time,better detection sensitivity and specificity,and can provide important basis for clinical diagnosis of elderly CAP.

关 键 词：肺泡灌洗液 基因组二代测序 ILLUMINA 社区获得性肺炎 细菌培养鉴定 

分 类 号：R563.1[医药卫生—呼吸系统]