基于宏基因组测序结果探究咯血与下呼吸道病原微生物感染的联系  

Correlation between hemoptysis and lower respiratory tract pathogen infections based on metagenomic sequencing

作　　者：李娟[1] 沈毅 欧思华 林小靖 黄俊涛 张健兴 邱曦 莫展杰 刘春丽[1] Li Juan;Shen Yi;Ou Sihua;Lin Xiaojing;Huang Juntao;Zhang Jianring;Qiu Xi;Mo Zhanjie;Liu Chunli(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Guangzhou Medical University,National Center for Respiratory Medicine,National Clinical Research Center for Respiratory Disease,State Key Laboratory of Respiratory Disease,Guangzhou Institute of Respiratory Health,Guangzhou 510120,China)

机构地区：[1]广州医科大学附属第一医院呼吸与危重症医学科、国家呼吸医学中心、国家呼吸系统疾病临床医学研究中心、呼吸疾病国家重点实验室、广州呼吸健康研究院,广州510120

出　　处：《国际呼吸杂志》2024年第11期1277-1284,共8页International Journal of Respiration

基　　金：广东省自然科学基金(2023A1515010443);广州市科技计划项目(2023B03J1387);2023年度呼吸疾病国家重点实验室自主课题项目(SKLRD-Z-202313);广州医科大学学生创新能力提升计划项目(01-408-2201096)。

摘　　要：目的探究下呼吸道病原微生物感染与咯血发生的联系。方法本研究为横断面研究。采用非随机抽样法, 收集2019年11月至2022年2月于广州医科大学附属第一医院通过常规检测手段无法找出病原微生物而行病原微生物宏基因组测序(mNGS)的下呼吸道感染患者739例, 其中614例符合纳入标准。根据是否既往有咯血病史或入院后诊断为咯血(排除呕血及鼻衄), 将患者分为咯血组(172例)和非咯血组(442例), 比较2组患者支气管肺泡灌洗液病原微生物mNGS结果和临床特征。根据咯血的常见病因(支气管扩张症、肺结核、肺曲霉病和肺癌等疾病)及咯血量(少量、中量、大量)进行分层, 并比较临床特征及病原微生物mNGS结果。结果咯血组男90例, 女82例, 年龄53.50(44.00, 64.75)岁, 年龄范围为20~83岁。非咯血组男252例, 女190例, 年龄55.00(43.75, 65.00)岁, 年龄范围为19~85岁。与非咯血组患者相比, 咯血组患者中性粒细胞百分比、单核细胞百分比和红细胞沉降率降低, 淋巴细胞百分比升高, 更易出现凝血功能异常, 差异均有统计学意义(均P<0.05)。2组患者的性别、年龄、血糖、嗜酸性粒细胞百分比、高血压、糖尿病和鼻窦炎的分布差异均无统计学意义(均P>0.05)。咯血组和非咯血组中病原微生物mNGS为阴性的患者分别为38例(22.09%)和130例(29.41%), 差异无统计学意义(χ^(2)=3.34, P=0.068);混合感染的患者分别为79例(45.93%)和191例(43.21%), 差异无统计学意义(χ^(2)=0.37, P=0.542)。咯血组感染铜绿假单胞菌(χ^(2)=40.09, P<0.001)和流感嗜血杆菌(χ^(2)=6.40, P=0.011)的感染率较非咯血组高, 非咯血组感染人疱疹病毒4型(χ^(2)=7.46, P=0.006)和耶氏肺孢子菌(χ^(2)=7.62, P=0.006)的感染率较咯血组高, 差异均有统计学意义。咯血组铜绿假单胞菌的序列数较非咯血组高, 差异有统计学意义(Z=2.49, P=0.013)。疾病分层分析显示, 咯血组中支�Objective:To investigate the correlation between lower respiratory tract pathogenic microbial infections and the occurrence of hemoptysis.Methods:This was a cross-sectional study.Using a non-random sampling method,we collected data from 739 patients who underwent fiberoptic bronchoscopy and metagenomic next-generation sequencing(mNGS)at the First Affiliated Hospital of Guangzhou Medical University between November 2019 and February 2022.A total of 614 eligible patients were included and divided into hemoptysis(172 cases)and non-hemoptysis groups(442 cases)based on their previous history of hemoptysis or diagnosis upon admission(excluding hematemesis and epistaxis).We compared the metagenomic sequencing results of bronchoalveolar lavage fluid(BALF)and clinical characteristics between the two groups,and subgroups stratified based on common causes of hemoptysis(such as bronchiectasis,pulmonary tuberculosis,pulmonary aspergillosis,and lung cancer)and the volume of hemoptysis(small,medium and large volumes).Results:In the hemoptysis group,there were 90 males and 82 females,with a median age of 53.50(44.00,64.75)years,ranging from 20 to 83 years.In the non-hemoptysis group,there were 252 males and 190 females,with a median age of 55.00(43.75,65.00)years,ranging from 19 to 85 years.Compared to the non-hemoptysis group,patients in the hemoptysis group exhibited significantly lower percentages of neutrophils and monocytes,lower erythrocyte sedimentation rate,higher lymphocyte percentage,and higher tendency for coagulation abnormalities(all P<0.05).No significant differences in the sex,age,blood glucose levels,eosinophil percentages,hypertension,diabetes,and sinusitis were found between groups(all P>0.05).Negative mNGS results were detected in 38 patients(22.09%)of the hemoptysis group,and 130 patients(29.41%)of the non-hemoptysis group,showing no significant difference(χ^(2)=3.34,P=0.068).Mixed infections were identified in 79 patients(45.93%)of the hemoptysis group and 191 patients(43.21%)of the non-hemoptysis group,wit

关 键 词：咯血 铜绿假单胞菌 支气管扩张症 病原微生物 宏基因组测序 

分 类 号：R56[医药卫生—呼吸系统] R441.7[医药卫生—内科学]