肺泡灌洗液宏基因组二代测序对老年人肺曲霉菌病的诊断价值研究  

Study on the diagnostic value of BALF mNGS for pulmonary aspergillosis in elderly patients

作　　者：李蕤 苗桂玲[1] 李珊珊[1] 任丽君 田亚琼[1] LI Rui;MIAO Guiling;LI Shanshan;REN Lijun;TIAN Yaqiong(Department of Respiratory and Critical Care Medicine,the Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院呼吸与危重症医学科,江苏省南京市210008

出　　处：《实用老年医学》2024年第9期916-919,共4页Practical Geriatrics

摘　　要：目的 研究肺泡灌洗液(bronchial alveolar lavage fluid, BALF)宏基因组二代测序(metagenomic next-generation sequencing, mNGS)在老年肺曲霉菌病中的诊断价值。方法 纳入190例符合肺曲霉菌病诊断的病人,按照年龄≥60岁分为老年组和非老年组,分析传统微生物培养、血清曲霉半乳甘露聚糖抗原检测(GM试验)、BALF GM试验及BALF mNGS在2组病人中的阳性率。结果 老年组和非老年组中BALF mNGS阳性率最高,其次为BALF GM试验。2组BALF GM试验阳性率差异有统计学意义。ROC曲线得出老年组和非老年组BALF GM试验的诊断效能均优于血清GM试验,且老年组BALF GM试验的敏感度和特异度高于非老年组。在血清GM试验<0.5的99例老年病人中,61例行BALF mNGS,49例(80.3%)阳性;BALF GM试验<0.8的28例老年病人中,26例行BALF mNGS,全部阳性。结论 老年人和非老年人肺曲霉菌病诊断中,BALF mNGS阳性率最高,其次为BALF GM试验。对于GM试验阴性仍高度怀疑肺曲霉菌感染的病人行BALF mNGS将大大提高检出率,BALF GM试验结合BALF mNGS检测将使肺曲霉菌病的诊断准确率显著提高。Objective To investigate the diagnostic value of bronchial alveolar lavage fluid(BALF)metagenomic next-generation sequencing(mNGS)for pulmonary aspergillosis in the elderly patients.Methods A total of 190 patients with pulmonary aspergillosis were enrolled in this study,and were divided into the elderly group and the non-elderly group.The diagnostic value of traditional microbial culture,serum galactomannan antigen(GM)test,BALF GM test and BALF mNGS were investigated in the two groups.Results The positive rate of BALF mNGS was highest in the elderly group and the non-elderly group,followed by BALF GM test.There was significant difference in the positive rate of GM test between the two groups.Receiver operating characteristic(ROC)curve analysis showed that the diagnostic efficiency of BALF GM test was higher than that of serum GM test in the elderly group and the non-elderly group.The sensitivity and specificity of BALF GM test in the elderly group were higher than those in the non-elderly group.A total of 61 cases out of 99 elderly patients presenting with serum GM test less than 0.5 underwent BALF mNGS,and the positive rate of aspergillus was 80.3%.A total of 26 cases out of 28 elderly patients presenting with BALF GM test less than 0.8 underwent BALF mNGS,and the positive rate of aspergillus was 100%.Conclusions In the diagnosis of pulmonary aspergillosis in the elderly patients,the positive rate of BALF mNGS was higher than GM test and traditional microbial culture.Thus,BALF mNGS shows better diagnostic efficacy.In the elderly patients who are highly suspected of aspergillus infection despite the negative results of traditional microbial detection and GM test,BALF mNGS is an advantageous supplementary detection method.

关 键 词：肺曲霉菌病 曲霉菌半乳甘聚糖抗原检测试验 肺泡灌洗液 宏基因组二代测序 

分 类 号：R519[医药卫生—内科学]