二代测序技术在免疫抑制宿主肺部感染诊断及治疗中的价值  

The value of next-generation sequencing technology in the diagnosis of lung infections in immunosuppressed hosts and in their treatment

作　　者：周灿富 刘杼升 李科昌 詹炎坤 蔡英丽[1] ZHOU Canfu;LIU Zhusheng;LI Kechang;ZHAN Yankun;CAI Yingi(Department of Emergency Medicine,Zhaoqing First People's Hospital,Zhaoqing 526000,China)

机构地区：[1]肇庆市第一人民医院急诊科,广东肇庆526000

出　　处：《延安大学学报（医学科学版）》2024年第4期24-29,共6页Journal of Yan'an University:Medical Science Edition

基　　金：肇庆市科技计划项目(2022040307013)。

摘　　要：目的探究二代测序技术在免疫抑制宿主肺部感染诊断及治疗中的价值。方法选取2022年7月1日至2023年6月30日在肇庆市第一人民医院住院的免疫抑制宿主肺部感染患者100例为研究对象,使用单双号法分组,每组50例。取两组患者痰样本和肺泡灌洗液,单号组使用依赖于微生物培养的传统检测,双号组基于多重聚合酶链式反应的靶向二代测序(targeted next-generation sequencing,tg-NGS)对病原体进行检测,后依据检测结果分别进行相应治疗。利用统计学分析传统检测和tg-NGS检测对肺部感染的检测灵敏度;分析依据传统检测和tg-NGS检测结果的给药方式与患者体温恢复时间及住院时间的关系。结果观察组和对照组对细菌类病原体和真菌类病原体都具有较高检出率;观察组对病毒类病原体的检出率均显著高于对照组(P<0.05),且对照组对病毒类病原体的检出率为0;对照组检出病原体大多为单致病病原体,仅有2例被检出为双致病病原体;而观察组对两种及以上致病病原体的检出率显著高于对照组(P<0.05)。与传统检测比较,tg-NGS检测显著提高了肺部感染病原体的检出率,提高了肺部感染检测的灵敏度(P<0.001);与传统检测治疗比较,tg-NGS检测治疗显著降低了血清C反应蛋白(C-reactive protein,CRP)、白介素-6(interleukin-6,IL-6)和降钙素原(procalcitonin,PCT)等炎症因子水平(P<0.001);显著缩短了患者的体温恢复时间和住院时间(P<0.001)。结论tg-NGS检测可提高免疫抑制宿主肺部感染病原菌的检出,提高肺部感染检测的灵敏度;依据tg-NGS结果制定的精准治疗可加快患者的治愈,避免药物滥用,缩短住院时间。Objective Exploring the value of next-generation sequencing technology in the diagnosis and treatment of lung infections in immunosuppressed host.Methods 100 patients with lung infections in immunosuppressed hosts hospitalized in the First People's Hospital of Zhaoqing from 1 July 2022 to 30 June 2023 were selected and grouped into groups of 50 cases each using the single and double number method.Sputum samples and alveolar lavage fluid were taken from the two groups of patients,and the pathogens were detected using microbiological culture-dependent conventional assays and multiplex PCR-based targeted next-generation sequencing(tg-NGS),respectively,and the appropriate treatments were administered based on the results of the assays.The sensitivity of conventional and tg-NGS tests for detecting lung infections was analysed statistically,and the relationship between drug administration based on the results of conventional and tg-NGS tests and the patients'temperature recovery time and hospital stay was analysed.Results The detection rates of bacterial and fungal pathogens in both the observation and control groups were high;the detection rates of viral pathogens in the observation group were significantly higher than those in the control group(P<0.05),and the detection rate of viral pathogens in the control group was 0;most of the pathogens detected in the control group were single pathogens,and only two cases were detected as double pathogens;whereas,the detection rates of two or more pathogens in the observation group were significantly higher than those in the control group(P<0.05).The detection rate of two or more pathogens in the observation group was significantly higher than that in the control group(P<0.05).Compared with the traditional test,tg-NGS significantly increased the detection rate of lung infection pathogens and improved the sensitivity of lung infection detection(P<0.001);compared with the traditional test treatment,tg-NGS significantly reduced the levels of inflammatory factors such as serum C-re

关 键 词：二代测序 靶向二代测序 免疫抑制 肺部感染 精准医学 

分 类 号：R563.1[医药卫生—呼吸系统]