宏基因组二代测序在食管气管瘘气道支架置入术后肺炎病原体检测中的价值  

Value of metagenomic next-generation sequencing to the pathogen detection after tracheoesophageal fistula airway stenting

作　　者：秦芳 高永平 王书方 荆蕾 王辉 李小丽 张洁莉 周云芝 QIN Fang;GAO Yongping;WANG Shufang;JING Lei;WANG Hui;LI Xiaoli;ZHANG Jieli;ZHOU Yunzhi(Department of Respiratory and Critical Care Medicine,Emergency General Hospital,Beijing 100028,China)

机构地区：[1]应急总医院呼吸与危重症医学科,北京100028

出　　处：《中华实用诊断与治疗杂志》2024年第1期75-80,共6页Journal of Chinese Practical Diagnosis and Therapy

基　　金：应急总医院医学发展科研基金项目(K202008,K201909)。

摘　　要：目的 观察食管气管瘘气道支架置入术后肺炎患者支气管肺泡灌洗液(BALF)、防污染样本毛刷(PSB)采样分别行宏基因组二代测序(mNGS)和病原体培养的病原体检出情况,探讨mNGS在病原学诊断中的价值。方法 2020年8月—2021年8月应急总医院诊治食管气管瘘气道支架置入术后肺炎患者48例,抗感染治疗前行支气管镜检查,采集BALF和PSB采样,分别行mNGS及病原体培养检查;采集痰标本行病原体培养检查。比较5种方法病原体检出率;分析5种方法检出病原体种类及分布情况;比较BALF mNGS与PSB采样mNGS检出主要病原体序列数。结果 BALF mNGS病原体检出率(95.83%)与PSB采样mNGS(95.83%)比较差异无统计学意义(χ^(2)<0.001,P>0.999);BALF培养(37.50%)、PSB采样培养(33.33%)、痰培养(33.33%)病原体检出率比较差异无统计学意义(χ^(2)=0.170,P>0.999),均低于BALF mNGS、PSB采样mNGS(P<0.05)。BALF mNGS共检出51种病原体,其中细菌36种(70.59%)132株,主要为纹带棒状杆菌22株、铜绿假单胞菌20株、嗜麦芽寡养单胞菌16株;真菌5种(9.80%)13株,分别为白假丝酵母菌6株、热带假丝酵母菌4株,黄曲霉1株,烟曲霉1株,光滑假丝酵母菌1株;病毒10种(19.61%)33株,主要为人疱疹病毒4型10株,人单纯疱疹病毒1型7株,人疱疹病毒7型6株。PSB采样mNGS共检出46种病原体,其中细菌33种(71.74%)125株,主要为纹带棒状杆菌21株,铜绿假单胞菌17株,嗜麦芽寡养单胞菌17株;真菌4种(8.70%)9株,分别为白假丝酵母菌4株,热带假丝酵母菌3株,黄曲霉、光滑假丝酵母菌各1株;病毒9种(19.57%)19株,主要为人疱疹病毒4型6株,人单纯疱疹病毒1型3株,人疱疹病毒7型3株。BALF培养共检出9种病原体,其中细菌7种(77.78%)21株,主要为铜绿假单胞菌9株,肺炎克雷伯菌4株,嗜麦芽寡养单胞菌2株;真菌2种(22.22%)2株,分别为白假丝酵母菌1株,热带假丝酵母菌1株;未检出病毒。PSB采样培养共检出8种病原体,其中�Objective To observe the detection results of pathogens by bronchoalveolar lavage fluid(BALF)metagenomic next-generation sequencing(mNGS),protected specimen brush(PSB) mNGS,BALF culture and PSB culture in pneumonia patients after tracheoesophageal fistula airway stenting,and to investigate the value of mNGS to the pathogen diagnosis.Methods Forty-eight patients with pneumonia after tracheoesophageal fistula airway stenting in Emergency General Hospital from August 2020 to August 2021 underwent bronchoscopy before anti-infection treatment to collect BALF and PSB samples.mNGS and pathogen culture were conducted.Additionally,sputum specimens were collected for pathogen culture.The positive rates of pathogens were compared among five methods.The type and distribution of pathogen of five methods were analyzed.The number of main pathogen sequences detected by BALF mNGS was compared with that of PSB mNGS.Results There was no significant difference in the positive rate of pathogen by BALF mNGS(95.83%) compared with that by PSB mNGS(95.83%)(χ^(2) <0.001,P>0.999),and in the positive rate of pathogen by BALF culture(37.50%),PSB culture(33.33%) and sputum culture(33.33%)(χ^(2)=0.170,P>0.999).The positive rates of pathogens by BALF culture,PSB culture and sputum culture were lower than those by BALF mNGS and PSB mNGS(P <0.05).BALF mNGS identified 51 pathogens,in which 36 bacteria(70.59%) with 132 strains were detected,mainly including 22 strains of Corynebacterium striatum,20 strains of Pseudomonas aeruginosa,and 16 strains of Stenotrophomonas maltophilia;5 fungi(9.80%) with 13 strains were identified,including 6 strains of Candida albicans,4 strains of Candida tropicalis,1 strain of Aspergillus flavus,1 strain of Aspergillus fumigatus,and 1 strain of Candida glabrata;10 viruses(19.61%) with 33 strains were detected,including 10 strains of human herpes virus type 4,7 strains of human herpes simplex virus type 1,and 6 strains of human herpes virus type 7.PSB mNGS identified 46 pathogens,in which 33 bacteria(71.74%) with 125

关 键 词：食管气管瘘 气道支架置入术 肺炎 支气管肺泡灌洗 防污染样本毛刷 宏基因组二代测序 痰培养 

分 类 号：R446.5[医药卫生—诊断学]