mNGS在老年社区获得性肺炎病原学诊断的临床价值  

Clinical value of mNGS in pathogen diagnosis of elderly patients with community-acquired pneumonia

作　　者：李兴明[1] 谢秀芳[1] 王宪刚[1] 李云[1] 袁翊[2] LI Xing-ming;XIE Xiu-fang;WANG Xian-gang;LI Yun;YUAN Xiang(Pulmonary and Critical Care Department,the First People′s Hospital of Neijiang,Neijiang 641000,Sichuan,China)

机构地区：[1]内江市第一人民医院呼吸与危重症学科,四川内江641000 [2]内江市第一人民医院检验科,四川内江641000

出　　处：《广东医学》2024年第10期1326-1330,共5页Guangdong Medical Journal

基　　金：四川省医学(青年创新)科研课题(Q21050)。

摘　　要：目的 分析宏基因二代测序(metagenomic next-generation sequencing, mNGS)在老年社区获得性肺炎(community acquired pneumonia, CAP)病原学检测的临床价值。方法 以收治的112例老年CAP患者为研究对象,比较mNGS与常规微生物学试验(sconventional microbiological tests, CMTs)对病原体的检出效率。采用Fisher精确检验统计及ROC曲线分析其结果,比较mNGS与CMTs的诊断性差异。结果 mNGS对老年CAP患者的总诊断率优于CMTs,差异有统计学意义(94.6%vs. 65.2%,P<0.001);mNGS的检测时间显著低于CMTs的检测时间[(26.3±5.9)h vs.(85.5±6.4)h;t=21.034,P<0.05]。mNGS在细菌、病毒、真菌、非典型病原体的检测例数均高于CMTs。mNGS对混合感染标本检出率为76.4%,明显高于CMTs的60.3%(χ^(2)=6.851,P<0.05)。mNGS与CMTs的病原体检测一致者64例,部分一致者35例,完全不一致者13例。结论 mNGS对老年社区获得性肺炎能检测出更多和更广谱的病原体,且具有重要的临床价值。Objective To analyze the clinical value of metagenomic next-generation sequencing(mNGS)in the pathogen detection of elderly patients with community-acquired pneumonia(CAP).Methods A total of 112 elderly CAP patients were included in the study.The detection efficiency of pathogens using mNGS was compared with conventional microbiological tests(CMTs).Statistical analyses were conducted using Fisher′s exact test and ROC curves to evaluate the diagnostic differences between mNGS and CMTs.Results The overall diagnostic rate of mNGS was significantly higher than that of CMTs(94.6%vs.65.2%,P<0.001).The detection time for mNGS was significantly shorter than that for CMTs[(26.3±5.9)h vs.(85.5±6.4)h;t=21.034,P<0.05].mNGS detected a higher number of bacterial,viral,fungal,and atypical pathogens compared to CMTs.The detection rate for mixed infections with mNGS was 76.4%,significantly higher than CMTs′60.3%(χ^(2)=6.851,P<0.05).Of the detected pathogens,there were 64 cases of agreement,35 cases of partial agreement,and 13 cases of complete disagreement between mNGS and CMTs.Conclusion mNGS demonstrates superior capability in detecting a broader spectrum of pathogens in elderly patients with community-acquired pneumonia,highlighting its significant clinical value.

关 键 词：社区获得性肺炎 老年 宏基因二代测序 常规微生物学试验 肺泡灌洗液 

分 类 号：R563[医药卫生—呼吸系统] R446[医药卫生—内科学]