通过二代基因测序分析厌氧菌感染肺炎旁积液病原学及临床特征  

Clinical and etiological characteristics of parapneumonic effusion infected by anaerobic bacteria analyzed by metagenomic next-generation gene sequencing

作　　者：张莹[1] 李月川 张永祥[1] 马晖 叶蓁 卢芳 ZHANG Ying;LI Yue-chuan;ZHANG Yong-xiang;MA Hui;YE Zhen;LU Fang(Tianjin University Chest Hospital,Tianjin 300222,China)

机构地区：[1]天津大学胸科医院呼吸与危重症医学科,天津300222

出　　处：《中国实用内科杂志》2024年第6期496-501,共6页Chinese Journal of Practical Internal Medicine

基　　金：国家临床重点专科建设项目,天津市医学重点学科(专科)项目(TJYXZDXK-049A)。

摘　　要：目的 通过二代基因测序(mNGS)分析厌氧菌感染肺炎旁积液的病原学及临床特征。方法 选取2020年1月至2022年12月在天津市胸科医院呼吸与危重症医学科一病区住院行胸腔细管引流提示为肺炎伴肺炎旁积液同时胸腔积液送检(m NGS)的96例患者临床资料。回顾病历获取临床资料,根据mNGS结果,将患者分为厌氧菌感染组和非厌氧菌感染组,收集、分析、统计两组患者的菌种分布、临床症状、基础病、实验室检查、发病时间、引流次数、治疗时间、胸腔积液类型等。结果 共检出厌氧菌感染的肺炎旁积液54例,以消化链球菌、卟啉单胞菌为主。厌氧菌感染组的肺炎旁积液患者中发病时间,男性患者、饮酒、口腔疾病、合并睡眠呼吸暂停比例,低白蛋白水平、D-二聚体、C反应蛋白均高于非厌氧菌感染组(P<0.05)。Logistic多元回归结果显示饮酒、口腔疾病、发病时间、白蛋白水平是肺炎旁积液厌氧菌感染的影响因素(P<0.05)。厌氧菌感染组的肺炎旁积液类型以复杂性肺炎旁积液为主,引流次数、住院时间、胸腔注射尿激酶治疗均高于非厌氧菌组,治愈率低于非厌氧组,差异具有统计学意义(P<0.05)。结论 对于厌氧菌感染社区获得性肺炎伴肺炎旁积液患者,就诊时需注意患者口腔情况、饮酒史、睡眠打鼾等情况,如患者合并上述高危因素,应高度警惕合并厌氧菌感染,早期经验性应用抗厌氧菌治疗,缩短治疗时间,减少并发症发生。Objective To analyze etiological and clinical characteristics of parapneumonic effusion infected by anaerobic bacteria through metagenomic next-generation sequencing(mNGS). Methods The clinical data of 96 patients hospitalized in the Respiratory and Critical Care Medicine First Ward of Tianjin Chest Hospital from January 2020 to December 2022were selected,who were with pneumonia with parapneumonic effusion indicated by thoracic tube drainage and had examination of pleural effusion(mNGS). Clinical data were obtained by reviewing medical records. According to the results of mNGS,the patients were divided into anaerobic bacteria infection group and non-anaerobic bacteria infection group. The bacteria distribution,clinical symptoms,basic diseases,laboratory examination,disease onset time,drainage frequency,treatment time and pleural effusion type of patients in the two groups were collected,analyzed and counted. Results A total of 54 cases of parapneumonic effusion infected by anaerobic bacteria were detected,mainly peptostreptococcus and porphyromonas. The proportion of male patients,time of onset,alcohol consumption,oral disease,combination with sleep apnea,low albumin level,D-dimer and C-reactive protein in patients with parapneumonic effusion infected by anaerobic bacteria were higher than those in non-anaerobic infection group(P<0.05). Logistic multiple regression results showed that alcohol drinking,oral disease,onset time and albumin level were the influencing factors of anaerobic bacteria infection in parapneumonic effusion(P<0.05). The types of parapneumonic effusion infected by anaerobic bacteria were mainly complicated parapneumonic effusion,and the frequency of drainage,length of hospital stay and thoracic urokinase injection were higher than those in non-anaerobic bacteria group, and the cure rate was lower than that of non-anaerobic group,the differencesbeing statistically significant(P<0.05).Conclusion For patients with community-acquired pneumonia with anaerobe infection and parapneumonic effusion,ora

关 键 词：二代基因测序 厌氧菌感染 肺炎旁积液 病原菌分布 临床特征 

分 类 号：R561.3[医药卫生—呼吸系统]