肺泡灌洗液tNGS技术在下呼吸道感染患者中的应用  

Application of Alveolar Lavage Fluid tNGS Technique in Patients With Lower Respiratory Tract Infection

作　　者：李培根 白英连 黄秋惠 黄华 汪明星 LI Peigen;BAI Yinglian;HUANG Qiuhui;HUANG Hua;WANG Mingxing(Department of Respiratory and Critical Care Medicine,Lianzhou People′s Hospital,Guangdong Province,Lianzhou Guangdong 513400,China)

机构地区：[1]广东省连州市人民医院呼吸与危重症医学科,广东连州513400

出　　处：《中国卫生标准管理》2024年第17期126-130,共5页China Health Standard Management

摘　　要：目的探讨肺泡灌洗液多重靶向扩增-高通量测序法(targeted next-generation sequencing,tNGS)技术在下呼吸道感染患者中的应用效果。方法选取2022年1月—2023年5月于广东省连州市人民医院住院的176例下呼吸道感染患者为研究对象,所有患者均接受肺泡灌洗液tNGS检测、灌洗液细菌培养、灌洗液结核分枝杆菌及利福平耐药检测(Xpert)、灌洗液半乳甘露聚糖检测(曲霉抗原,glactomannan,GM试验)、灌洗液真菌培养。比较5种检测方法对不同病原体的检出率,分析肺泡灌洗液tNGS检测下不同病原体分布特点,并对肺泡灌洗液tNGS检测和灌洗液细菌培养检测一致性分析。结果肺泡灌洗液tNGS检出率为92.05%,高于灌洗液细菌培养检测的22.16%,Xpert检测的9.09%,GM试验的16.48%以及灌洗液真菌培养的8.52%,差异有统计学意义(P<0.05)。球菌中检出率前3位为肺炎链球菌、粪肠球菌、金黄色葡萄球菌;杆菌中检出率前3位为流感嗜血杆菌、溶血嗜血杆菌、大肠埃希菌;真菌主要为白念珠菌和肺孢子菌;其他病原体主要为结核分枝杆菌;在常见呼吸道病毒中,疱疹病毒较为常见,其次为甲型流感病毒和鼻病毒;肺泡灌洗液tNGS检测和灌洗液细菌培养结果、灌洗液真菌培养存在一致性偏差。结论肺泡灌洗液tNGS检测技术可提高下呼吸道感染病原体检出率,该检测方式可作为下呼吸道感染病原体检测的有效检测方法,为临床治疗提供指导。Objective To explore the application effect of alveolar lavage fluid targeted next-generation sequencing(tNGS)technique on patients with lower respiratory tract infection.Methods A total of 176 patients with lower respiratory tract infection who were hospitalized in Lianzhou People′s Hospital,Guangdong Province from January 2022 to May 2023 were selected as the study subjects.All patients underwent alveolar lavage fluid tNGS detection,bacterial culture in lavage fluid,lavage fluid Mycobacterium tuberculosis and rifampicin resistance detection(Xpert),lavage fluid galactomannan detection(aspergillus antigen,GM detection)and fungal culture in lavage fluid.The detection rates of different pathogenic bacteria were compared among the five detection methods.The distribution characteristics of different pathogenic bacteria under alveolar lavage fluid tNGS detection were analyzed,and the consistency between alveolar lavage fluid tNGS detection and lavage fluid bacterial culture detection was analyzed.Results The detection rate of alveolar lavage fluid tNGS was 92.05%,which was significantly higher than that of lavage fluid bacterial culture detection(22.16%),Xpert detection(9.09%),GM detection(16.48%)and lavage fluid fungal culture(8.52%)(P<0.05).The top three detection rates of cocci were Streptococcus pneumoniae,Enterococcus faecalis and Staphylococcus aureus.The top three detection rates of bacilli were Haemophilus influenzae,Haemophilus haemolyticus and Escherichia coli.Fungi were mainly Candida albicans and Pneumocystis.Other pathogenic bacteria were mainly Mycobacterium tuberculosis.Among the common respiratory tract viruses,herpes virus was more common,followed by influenza A virus and rhinovirus.There was a consistency deviation between alveolar lavage fluid tNGS detection and lavage fluid bacterial culture results and lavage fluid fungal culture.Conclusion Alveolar lavage fluid tNGS detection can improve the detection rates of pathogenic bacteria of lower respiratory tract infection,and this detection method ca

关 键 词：下呼吸道感染 肺泡灌洗液 呼吸道病原体靶向测序 灌洗液细菌培养 灌洗液半乳甘露聚糖检测 灌洗液真菌培养 

分 类 号：R373[医药卫生—病原生物学]