高渗盐水雾化下痰呼吸道病原体靶向测序对难治性肺部感染微生物诊断价值的临床研究  

Clinical study on the diagnostic value of targeted next-generation sequencing of sputum and respiratory pathogens under hypertonic saline nebulization for the microbiological diagnosis of refractory pulmonary infection

作　　者：罗显 魏兴英 黎教武 黄钰成 LUO Xian;WEI Xingying;LI Jiaowu;HUANG Yucheng(Department of Respiratory and Critical Care Medicine,Lecong Hospital of Shunde Foshan,Guangdong,Foshan 528315,China;Department of Radiology,Lecong Hospital of Shunde Foshan,Guangdong,Foshan 528315,China)

机构地区：[1]广东省佛山市顺德区乐从医院呼吸与危重症医学科,广东佛山528315 [2]广东省佛山市顺德区乐从医院放射科,广东佛山528315

出　　处：《中国医药科学》2024年第22期146-149,175,共5页China Medicine And Pharmacy

基　　金：广东省佛山市卫生健康局医学科研课题拟立项项目(20230821A010302)。

摘　　要：目的探究高渗盐水雾化下痰呼吸道病原体靶向测序(tNGS)+痰普通病原学检测对难治性肺部感染微生物诊断价值。方法选择佛山市顺德区乐从医院2023年4月至2024年7月收治的难治性肺部感染患者50例为研究对象,按随机排列表法分为3组,对照组(n=16,痰普通病原学检测),观察A组(n=17,高渗盐水雾化+呼吸道病原体tNGS+痰普通病原学检测),观察B组(n=17,高渗盐水雾化+痰普通病原学检测),通过所获取的微生物学结果选择抗菌素治疗,观察患者的临床症状改变、生化指标的动态变化及胸部影像学病灶的吸收情况。结果观察A组和观察B组的发热、咳嗽、咳痰、肺部啰音消退时间均显著短于对照组,观察A组的发热、咳嗽消退时间均显著短于观察B组,差异有统计学意义(P<0.05)。治疗前,三组白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)水平比较,差异无统计学意义(P>0.05);治疗后,观察A组和观察B组的WBC、CRP、PCT水平均显著低于对照组,观察A组的PCT、CRP、WBC水平均低于观察B组,差异有统计学意义(P<0.05)。三组治疗后PCT、CRP、WBC水平均显著低于治疗前,差异有统计学意义(P<0.05)。呼吸道病原体tNGS病原体菌种检测结果显示,细菌在病原体中占比最高,其中细菌中肺炎克雷伯菌占比最高,为11.76%(2/17),病毒中人类疱疹病毒占比最高,为17.65%(3/17),真菌中烟曲霉占比最高,为3.46%(1/17),其他病原体中结核分枝杆菌占比最高,为3.46%(1/17)。观察A组和观察B组的病灶吸收时间显著短于对照组,观察A组的病灶吸收时间显著短于观察B组,差异有统计学意义(P<0.05)。结论高渗盐水雾化下痰呼吸道病原体tNGS对难治性肺部感染微生物病原体的识别和诊断精准,可进行针对治疗,明显改善预后,患者临床症状、感染指标改善,为难治性肺部感染的临床治疗提供更经济易行、有效的手段,建议推广。Objective To investigate the diagnostic value of targeted next generation sequencing(tNGS)of sputum and respiratory pathogens under hypertonic saline nebulization combined with sputum general pathogen detection for the microbiological diagnosis of refractory pulmonary infection.Methods A total of 50 patients with refractory pulmonary infection admitted to Lecong Hospital of Shunde Foshan from April 2023 to July 2024 were selected as the research objects,and they were divided into the control group(n=16,treated with common pathogen detection of sputum),the observation group A(n=17,treated with hypertonic saline nebulization+respiratory pathogen tNGS+common pathogen detection of sputum),and the observation group B(n=17,treated with hypertonic saline nebulization+common pathogen detection of sputum)according to the random number table method.Through the obtained microbiological results,antibiotic treatment was selected,and the changes of clinical symptoms,dynamic changes of biochemical indices and absorption of chest imaging lesions of patients were observed.Results The disappearance time of fever,cough,expectoration and lung rales in observation group A and observation group B were all significantly shorter than that in the control group,and the disappearance time of fever and cough in observation group A were significantly shorter than that in the observation group B,with statistically significant differences(P<0.05).Before treatment,there was no statistically significant difference in the levels of white blood cell count(WBC),C-reactive protein(CRP),and procalcitonin(PCT)among the three groups(P>0.05).After treatment,the levels of WBC,CRP and PCT in observation group A and observation group B were all significantly lower than those in the control group,and the levels of PCT,CRP and WBC in the observation group A were all lower than those in the observation group B,with statistically significant differences(P<0.05).After treatment,the levels of PCT,CRP and WBC were all significantly lower than those before treatme

关 键 词：高渗盐水雾化 痰呼吸道病原体 靶向测序 难治性肺部感染 微生物 

分 类 号：R563.1[医药卫生—呼吸系统]