经电子支气管镜下肺泡灌洗液行宏基因组测序在呼吸机相关性肺炎的应用价值  

Application value of metagenomic next-generation sequencing with alveolar lavage fluid under electronic bronchoscope in ventilator-associated pneumonia

作　　者：陈伟光 张晶晶 江春虾 郑耿正 胡欣欣 罗时俊 CHEN Wei-guang;ZHANG Jing-jing;JIANG Chun-xia(Department of Internal Medicine,Pingshan District People's Hospital,Shenzhen 518118,China)

机构地区：[1]深圳市坪山区人民医院内科,518118

出　　处：《中国现代药物应用》2024年第2期12-16,共5页Chinese Journal of Modern Drug Application

基　　金：深圳市坪山区卫生系统科研项目(由坪山区医疗集团发展补助资金资助)(项目编号:202160)。

摘　　要：目的探讨经电子支气管镜下肺泡灌洗液行宏基因组二代测序(mNGS)在呼吸机相关性肺炎(VAP)患者中的应用价值,为患者的临床诊断及针对性治疗提供相关参考依据。方法40例VAP患者作为研究对象,根据随机数字表法分为对照组与mNGS组,各20例。两组均行经电子支气管镜下肺泡灌洗,对照组应用传统病原微生物检测,mNGS组应用mNGS。对比两组患者的病原体种类检出率、病原体种类数检出率、抗生素使用强度(包括抗生素使用率及使用时间)、机械通气时间、重症加强护理病房(ICU)住院时间、多器官功能障碍综合征(MODS)发生率及两种检测方式对VAP的诊断效能。结果mNGS组患者的细菌检出率为80.00%,明显高于对照组的20.00%(P<0.05);两组真菌、病毒检出率比较,差异无统计学意义(P>0.05)。mNGS组患者病原体种类数>2种检出率为30.00%,明显高于对照组的0(P<0.05)。mNGS诊断VAP的曲线下面积(AUC)为0.941,明显大于传统病原微生物检测的0.714(P<0.05)。mNGS组患者的抗生素使用率55.00%明显低于对照组的90.00%,抗生素使用时间(11.21±2.08)d、机械通气时间(11.96±2.90)d、ICU住院时间(19.03±3.94)d明显短于对照组的(15.87±2.53)、(15.47±3.82)、(22.18±4.55)d,MODS发生率5.00%明显低于对照组的30.00%(P<0.05)。结论经电子支气管镜下肺泡灌洗液行mNGS在VAP患者中的应用价值较高,可以有效提高患者感染病原体的检出率,显著减少抗生素的使用强度及机械通气时间,对患者病情快速准确诊断、及时采取针对性治疗措施意义重大。Objective To explore the application value of metagenomic next-generation sequencing(mNGS)with alveolar lavage fluid under electronic bronchoscope in ventilator-associated pneumonia(VAP),and to provide relevant reference for clinical diagnosis and targeted treatment of patients.Methods 40 cases patients with VAP were selected as the research subjects.According to the random numerical table method,they were divided into control group and mNGS group,with 20 cases in each group.Both groups underwent alveolar lavage by electronic bronchoscope.The control group was detected by traditional pathogenic microorganisms,and the mNGS group was detected by mNGS.Both groups were compared in terms of detection rate of pathogen species,number of pathogen species,antibiotic use intensity(including antibiotic usage rate and duration),mechanical ventilation time,length of intensive care unit(ICU)stay,incidence of multiple organ dysfunction syndrome(MODS)were compared between the two groups,and diagnostic efficacy of the two detection methods for VAP was compared.Results The bacterial detection rate of the mNGS group was 80.00%,which was significantly higher than that of the control group's 20.00%(P<0.05).There was no significant difference in the detection rates of fungus and virus between the two groups(P>0.05).The detection rate of pathogen species>2 in the mNGS group was 30.00%,which was significantly higher than that in the control group's 0(P<0.05).The area under the curve(AUC)of mNGS in the diagnosis of VAP was 0.941,which was significantly higher than 0.714 in the traditional detection of pathogenic microorganisms(P<0.05).The antibiotic usage rate of 55.00%in the mNGS group was significantly lower than the control group's 90.00%;and antibiotic usage duration,mechanical ventilation time and length of ICU stay in mNGS group were(11.21±2.08),(11.96±2.90)and(19.03±3.94)d,which were significantly shorter than(15.87±2.53),(15.47±3.82)and(22.18±4.55)d in the control group;and the incidence of MODS in mNGS group was 5.00%,whic

关 键 词：呼吸机相关性肺炎 电子支气管镜 肺泡灌洗液 宏基因组二代测序 应用价值 

分 类 号：R563.1[医药卫生—呼吸系统]