摘要
目的探讨肺泡灌洗液宏基因二代测序技术(mNGS)对下呼吸道感染病原体检测的优势及指导治疗作用。方法回顾性分析2018年5月至2019年5月在浙江大学医学院附属邵逸夫医院就诊的下呼吸道感染患者56例,所有患者均行支气管镜肺泡灌洗夜mNGS检测与传统培养(包括痰培养及灌洗液培养)检查,比较灌洗液mNGS与传统培养检测的阳性率、检测病原体的分布、病原体检测的一致性;在传统培养阴性患者中,比较灌洗液mNGS阳性患者与灌洗液mNGS阴性患者的治疗效果;并利用多因素logistic回归法分析灌洗液mNGS对病原体检出率的影响因素。结果灌洗液m NGS检测的阳性率高于传统培养(69.6%对25.0%),差异有统计学意义(P<0.05)。在传统培养无法检测到病原体的患者中,根据灌洗液mNGS阳性结果调整抗病原微生物药物后治疗效果明显好于经验性抗感染治疗(88.0%对40.0%),差异有统计学意义(P<0.05)。多因素logistic回归法分析灌洗液mNGS对病原体检测的影响因素中,未发现有影响因素存在。结论采用灌洗液mNGS检测可以提高下呼吸道感染患者病原体的检出率,特别是对病毒、真菌及特殊病原体。在传统培养无法检测到病原体的患者中,灌洗液mNGS可以作为一种有效的检测方法,从而指导抗病原微生物药物的应用,提升治疗效果。未发现灌洗液mNGS对病原体检出率的影响因素。灌洗液mNGS在下呼吸道感染的诊断及治疗中有很高的临床应用价值。
Objective To investigate the advantages in pathogen detection of bronchoalveolar lavage fluid by metagenomic next-generation sequencing(mNGS)and the guiding effects on treatment in patients with lower respiratory tract infections.Methods This was a retrospective study of fifty-six patients with lower respiratory tract infections at the Run Run Shaw Hospital Affiliated to Medical School of Zhejiang University from May 2018 to May 2019.All patients underwent mNGS of bronchoscopy lavage fluid and traditional culture(including the lavage fluid and sputum culture).Compare the positive rate,the detected pathogen distribution and the consistency between mNGS and traditional culture.In the patients with negative results of traditional culture,compare the therapeutic effects between the patients with positive results and those with negative results of mNGS.The multivariate logistic regression analysis was used to analyze the factors affecting the positive rate of pathogens of lavage fluid by mNGS.Results The positive rate of lavage fluid by m NGS was higher than that by traditional culture(69.6%vs.25.0%),and the difference was statistically significant(P<0.05).In the patients whose pathogen couldn’t be detected with conventional culture,the treatment effect of the anti-infection therapy modified according to positive result of mNGS was significantly better than the effect of empirical treatment(88.0%vs.40.0%),and the difference was statistically significant(P<0.05).The multivariate logistic regression analys showed that m NGS of bronchoalveolar lavage fluid had no factors influencing pathogen detection.Conclusion The mNGS detection of bronchoalveolar lavage fluid can improve the positive rate of pathogens detection in patients with lower respiratory tract infections,especially for viruses,fungi and special pathogens.In the patients whose pathogen can’t be detected with conventional culture,mNGS of bronchoalveolar lavage fluid can be used as an effective detection method,and guide the application of anti-infection drugs and improve the therapeutic effect.No influencing factors of the pathogens detection by mNGS of bronchoalveolar lavage fluid are found.The mNGS of bronchoalveolar lavage fluid has great clinical values in the diagnosis and treatment of lower respiratory tract infection.
作者
钮月英
吴晓虹
应可净
NIU Yue-ying;WU Xiao-hong;YING Ke-jing(Department of Pulmonary and Critical Care Medicine,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China;Department of Respiratory and Critical Care Medicine,Jiaxing Second Hospital)
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2020年第9期754-758,共5页
Chinese Journal of Practical Internal Medicine
关键词
病原诊断
下呼吸道感染
宏基因二代测序
肺泡灌洗液
pathogenic diagnosis
lower respiratory tract infection
metagenomic next-generation sequencing
bronchoalveolar lavage fluid
作者简介
通信作者:应可净,电子信箱:ykjsrrsh@zju.edu.cn
