肺泡灌洗液快速现场评价联合宏基因组二代测序在重症肺炎患者中的应用价值  

Application Value of Rapid On-site Evaluation of Alveolar Lavage Fluid Combined with Metagenomic Next-generation Sequencing in Patients with Severe Pneumonia

作　　者：刘亚萌 李冠英 刘翠 朱劲松 张胜利 梁希军 LIU Yameng;LI Guanying;LIU Cui;ZHU Jinsong;ZHANG Shengli;LIANG Xijun(Department of Respiratory Medicine,Cangzhou People's Hospital,Cangzhou,Hebei 061000,China)

机构地区：[1]沧州市人民医院呼吸内科,河北沧州061000

出　　处：《临床误诊误治》2025年第1期45-49,共5页Clinical Misdiagnosis & Mistherapy

基　　金：沧州市重点研发计划指导项目(222106117)。

摘　　要：目的探讨肺泡灌洗液快速现场评价(ROSE)联合宏基因组二代测序(mNGS)在重症肺炎患者中的应用价值。方法筛选2021年10月至2024年4月治疗的94例重症肺炎患者进行前瞻性研究,随机分为对照组(常规病原学检查)47例与观察组(ROSE联合mNGS技术进行病原学检查)47例,均给予抗生素治疗。记录2组肺泡灌洗液有效病原体检出率、抗生素应用情况、发热时间、机械通气时间、住重症监护室时间,比较2组入院第1、4、7天临床肺部感染评分(CPIS)以及血清C反应蛋白(CRP)、降钙素原(PCT)水平。结果观察组肺泡灌洗液有效病原体检出率为97.87%(46/47),高于对照组的59.57%(28/47,P<0.05),且观察组可检出病毒及不常见病原体(如鹦鹉热衣原体、结核分枝杆菌、堪萨斯分枝杆菌)。与对照组比较,观察组抗生素使用时间、发热时间、机械通气时间、住重症监护室时间均较短,抗生素使用种类及调整频次较少(P<0.05)。2组入院第4、7天CPIS及血清CRP、PCT水平均较入院第1天降低,且随着治疗时间的增加而降低(P<0.05);与对照组比较,观察组入院第4、7天CPIS及外周血CRP、PCT水平均降低(P<0.05)。结论ROSE联合mNGS技术在重症肺炎患者中有较高的应用价值,可提高病原学检出率,及时明确病原体,从而快速指导临床精准治疗。Objective To investigate the application value of rapid on-site evaluation(ROSE)of alveolar lavage fluid combined with metagenomic next-generation sequencing(mNGS)in patients with severe pneumonia.Methods A prospective study was conducted on 94 patients with severe pneumonia treated from October 2021 to April 2024,and they were randomly divided into the control group(routine etiological examination,n=47)and the observation group(ROSE combined with mNGS technology for etiological examination,n=47),all of whom were given antibiotics.The effective pathogen detection rate of alveolar lavage fluid,antibiotic application,fever time,duration of mechanical ventilation and intensive care unit(ICU)stay were recorded in the two groups,and the clinical pulmonary infection score(CPIS)and serum peripheral blood C-reactive protein(CRP)and procalcitonin(PCT)levels were compared between the two groups at 1,4 and 7 d after admission.Results The effective pathogen detection rate of alveolus lavage fluid in the observation group was 97.87%(46/47),which was higher than that of the control group[59.57%(28/47)](P<0.05),and viruses and uncommon pathogens(such as chlamydia pectin,Mycobacterium tuberculosis,Mycobacterium kansans)could be detected in the observation group.Compared with the control group,the time of antibiotic use,fever time,duration of mechanical ventilation and length of ICU stay in the observation group were shorter,and the types of antibiotics used and the frequency of adjustment were less(P<0.05).The levels of CPIS,serum CRP and PCT in peripheral blood of the two groups on the 4th and 7th day after admission were lower than those on the 1st day,and decreased with the increase of treatment time(P<0.05).Compared with the control group,CPIS score,CRP and PCT levels in peripheral blood of the observation group were decreased on the 4th and 7th day after admission(P<0.05).Conclusion ROSE combined with mNGS technology has a high application value in patients with severe pneumonia,which can improve the etiological detection r

关 键 词：重症肺炎 快速现场评价 宏基因组二代测序 病原体 肺泡灌洗液 临床肺部感染评分 C反应蛋白 降钙素原 

分 类 号：R563.1[医药卫生—呼吸系统]