mNGS检测肺泡灌洗液病原体在儿童下呼吸道感染中的应用价值  

Application value of mNGS in the detection of alveolar lavage fluid pathogens in children with lower respiratory tract infection

作　　者：曾祥妮 李岚[1] 胡次浪[1] 杜云[1] 吴爱民[1] 朱晓华[1] ZENG Xiangni;CHEN Chen;LI Lan;DU Yun;WU Aimin(Jiangxi Provincial Children's Hospital,Jiangxi Nanchang,330000,China.)

机构地区：[1]江西省儿童医院,南昌330000

出　　处：《江西医药》2024年第6期524-529,544,共7页Jiangxi Medical Journal

基　　金：江西省卫生健康委科技计划,编号202211205。

摘　　要：目的本研究旨在深入探究支气管肺泡灌洗液宏基因二代测序技术(mNGS)在儿童重症或难治性下呼吸道感染病原学检测中的独特优势及其对临床治疗的指导意义。方法回顾性分析江西省儿童医院呼吸内科在2021年10月至2022年10月期间收治的50例重症或难治性下呼吸道感染患儿的临床资料,所有患儿均接受了肺泡灌洗液mNGS检测以及传统方法检测(包括痰培养、肺泡灌洗液培养、血培养、病原血清学检测等)。通过对mNGS及传统方法检测结果的分析和判读,比较不同检测方法的阳性率、病原学分布、监测时间及检测结果的一致性等多个关键指标。同时,我们结合患儿的临床资料,依据检测结果判断病原菌,并据此调整抗感染治疗方案。结果灌洗液mNGS检测的阳性率显著高于传统方法检测(96%vs 52%),且对细菌、病毒、真菌的检测阳性率同样高于传统方法。此外,传统病原菌培养的平均耗时超过72小时,而mNGS的检测时间仅为24小时,检测周期显著缩短。更重要的是,mNGS指导下的抗感染方案调整指导率明显高于传统方法检测(42%vs 6%)。结论支气管肺泡灌洗液mNGS技术的应用能够显著提高重症或难治性儿童下呼吸道感染病原体的检出率,为临床提供快速、准确的病原体检测手段。同时,该技术能够有效指导临床用药,提高治疗效果,降低死亡率,为儿童重症或难治性下呼吸道感染的诊疗提供了新的有力工具。Objective This study aims to delve into the unique advantages of metagenomic next-generation sequencing(mNGS)of bronchoalveolar lavage fluid in the etiological detection of severe or refractory lower respiratory infections in children and its guiding significance for clinical treatment.Methods We retrospectively analyzed the clinical data of 50 children with severe or refractory lower respiratory infections admitted to the Department of Respiratory Medicine of Jiangxi Provincial Children's Hospital from October 2021 to October 2022.All patients underwent mNGS detection of bronchoalveolar lavage fluid as well as traditional methods(including sputum culture,bronchoalveolar lavage fluid culture,blood culture,serological detection of pathogens,etc.).By analyzing and interpreting the results of mNGS and traditional methods,we compared key indicators such as the positive rate,etiological distribution,monitoring time,and consistency of test results among different detection methods.Meanwhile,combining the clinical data of the patients,we identified the pathogenic bacteria based on the test results and adjusted the anti-infective treatment plan accordingly.Results The positive rate of bronchoalveolar lavage fluid mNGS detection was significantly higher than that of traditional methods(96%vs 52%),and the positive rates for bacteria,viruses,and fungi were also higher than those of traditional methods.Additionally,the average time for traditional pathogen culture exceeded 72 hours,while the detection time for mNGS was only 24 hours,significantly reducing the detection cycle.More importantly,the guidance rate of anti-infective regimen adjustment under the guidance of mNGS was significantly higher than that of traditional methods(42%vs 6%).Conclusion The application of bronchoalveolar lavage fluid mNGS technology can significantly improve the detection rate of pathogens in severe or refractory lower respiratory infections in children,providing a rapid and accurate method for pathogen detection in clinical practice.At the same

关 键 词：儿童下呼吸道感染 病原监测 mNGS 支气管肺泡灌洗液 

分 类 号：R725.6[医药卫生—儿科]