宏基因靶向三代测序在下呼吸道感染病原体检测的诊断效能和临床价值  

Diagnostic performance and clinical value of metagene targeted third-generation sequencing in the detection of pathogens in infections of the lower respiratory tract

作　　者：金向红 黄向韵 陈鲜宝 华婷婷 张燕 Jin Xianghong

机构地区：[1]浙江东阳横店文荣医院,322100 [2]杭州迪安诊断技术集团股份有限公司/浙江省医疗诊断数字技术重点实验室,310030

出　　处：《浙江临床医学》2024年第6期807-809,813,共4页Zhejiang Clinical Medical Journal

摘　　要：目的比较宏基因靶向三代测序与传统血培养对于下呼吸道感染病原菌诊断性能差异。方法选取2022年7月到2023年7月下呼吸道感染患者90例,收集患者临床资料,采集肺泡灌洗液分别进行培养和宏基因靶向三代测序,比较两个方法的阳性率、一致性,病原体检出分布,混合感染检出率,耐药检出情况等。结果90例患者中,宏基因靶向三代测序和培养的阳性率分别为84.4%和24.4%,宏基因阳性率高于培养(P<0.05),无论在细菌、真菌还是特殊病原体上,宏基因的检出率均高于培养,尤其是在非常见病原体、体外难以培养或生长缓慢的病原体上,宏基因混合感染检出率高于培养,宏基因检出3例细菌耐药基因,并有2例在药敏试验中得到验证。结论相较于传统培养,宏基因靶向三代测序在下呼吸道感染病原微生物诊断上时效性更好,阳性率更高,病原微生物种类、数量检出更多,混合感染检出率更高,且能预测微生物抗生素耐药性,具有更高的诊断价值和临床意义。Objective To compare the diagnostic performance between metagenomic targeted third-generation sequencing and traditional culture in lower respiratory tract infection.Methods A total of 90 patients with lower respiratory tract infection from July 2022 to July 2023 in the Hospital were enrolled,their clinical information was collected,the alveolar lavage fluid was collected for culture and metagenomic targeted third-generation sequencing,and the positive rate and consistency,pathogen detection distribution,mixed infection detection rate,and drug resistance detection of the two methods were compared.Results Among 90 patients,the positive rates of Metagenomic targeted third-generation sequencing and culture were 84.4%and 24.4%,respectively,and the positive rate of metagegene was significantly higher than that of culture(P<0.05),whether in bacteria,fungi or special pathogens,the detection rate of metagenomic was higher than that of culture,especially on pathogens that were uncommon,difficult to culture in vitro or slow-growing,the detection rate of metagenomic in mixed infection was higher than that of culture,3 cases of bacterial resistance gene were detected in metagenomic,and 2 cases were verified in antimicrobial susceptibility tests.Conclusion Compared with traditional culture,metagenomic targeted third-generation sequencing has better timeliness,higher positive rate,higher detection rate of more types and quantities of pathogenic microorganisms,as well as mixed infection,and can predict microbial antibiotic resistance.It has vital diagnostic value and clinical significance in the diagnosis of pathogenic microorganisms of lower respiratory tract infection.

关 键 词：宏基因靶向三代测序 下呼吸道感染 肺泡灌洗液 诊断性能 

分 类 号：R446.5[医药卫生—诊断学] R56[医药卫生—临床医学]