支气管肺泡灌洗液宏基因组二代测序在老年重症肺炎中的应用价值  

The application value of metagenomic next-generation sequencing of bronchoalveolar lavage fluid in severe pneumonia in the elderly

作　　者：宋爱琳 赵春刚[1] 柳颖[1] 曹昌萌 宁书蔚 SONG Ailin;ZHAO Chungang;LIU Ying;CAO Changmeng;NING Shuwei(Geriatric Medicine Center,Dalian Friendship Hospital,Dalian,Liaoning 116001,China)

机构地区：[1]大连市友谊医院老年医学中心,辽宁大连116001

出　　处：《重庆医学》2025年第4期944-948,953,共6页Chongqing Medical Journal

摘　　要：目的研究支气管肺泡灌洗液(BALF)宏基因组二代测序(mNGS)在老年重症肺炎中的应用价值。方法选取2024年1-8月该院重症病房收治的老年重症肺炎患者48例,按照随机数字表法将其分为观察组及对照组,每组24例。对照组和观察组均在入住ICU 24 h内留取BALF,结合影像学检查选择病变最明显的部位进行灌洗。对照组标本于该院行传统培养;观察组一份标本外送基因检测机构行mNGS检测,另一份标本于该院行传统培养。比较观察组mNGS与同组传统培养、对照组的检测结果,病原体分布情况,患者入住ICU第4、7天的感染指标,预后情况。结果观察组mNGS检测阳性标本率、2种以上病原体标本率均高于同组传统培养和对照组,差异有统计学意义(P<0.05)。除鲍曼不动杆菌、白色念珠菌、光滑假丝酵母菌、植生拉乌尔菌外,观察组在真菌、病毒及少见病原体方面的检出量高于对照组。入住ICU后第4、7天,观察组体温、WBC、C反应蛋白、降钙素原水平均低于对照组,差异有统计学意义(P<0.05)。观察组ICU住院时间、机械通气时间短于对照组,住院费用少于对照组,差异有统计学意义(P<0.05)。结论BALF mNGS有助于早期明确混合病原体和少见病原体,提高阳性检测率、拓宽微生物的范围且缩短检测时间。Objective To investigate the application value of bronchoalveolar lavage fluid(BALF)metagenomic next-generation sequencing(mNGS)in elderly patients with severe pneumonia.Methods A total of 48 elderly patients with severe pneumonia admitted to the intensive care unit from January to August 2024 were selected and randomly divided into an observation group and a control group,with 24 patients in each group.BALF samples were collected within 24 hours of ICU admission from both groups,with lavage performed at the most radiologically evident lesion site.The control group underwent traditional culture at the hospital,while the observation group had one specimen sent for mNGS testing and another specimen subjected to traditional culture at the hospital.Comparison of detection results between mNGS and traditional culture in the observation group,pathogen distribution,infection markers(on days 4 and 7 of ICU admission),and prognostic outcomes were compared between the groups.Results The observation group showed higher positive detection rates and higher rates of detecting≥2 pathogens by mNGS compared to both traditional culture in the same group and the control group(P<0.05).Excluding Acinetobacter baumannii,Candida albicans,Candida glabrata,and Raoultella planticola,the observation group detected higher quantities of fungi,viruses,and rare pathogens than the control group.On days 4 and 7 of ICU admission,the observation group had significantly lower body temperature,white blood cell count,C reactive protein,and procalcitonin levels compared to the control group(P<0.05).The observation group also demonstrated shorter ICU stays,reduced mechanical ventilation duration,and total lower hospitalization costs than the control group(P<0.05).Conclusion BALF mNGS facilitates early identification of mixed and rare pathogens,improves detection rates,broadens microbial coverage,and shortens testing time.

关 键 词：支气管肺泡灌洗液 肺炎 宏基因组学 老年患者 

分 类 号：R563[医药卫生—呼吸系统]