摘要
目的探讨高通量检测基因芯片测序技术对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并社区获得性肺炎病原体检测可行性。方法选择2017年1月至2018年5月在我院接受治疗的128例疑似COPD并发社区获得性肺炎患者进行研究。所有患者均在使用抗生素前采集合格痰标本、肺泡灌洗液标本,均同时进行病原学临床检测和高通量测序,并对高通量测序的结果采用PCR方法进行确认,然后对基于高通量测序的慢阻肺合并肺炎病原体检测方法进行评估。参照《中国成人社区获得性肺炎诊断和治疗指南(2016年版)》中致病原的主要检测方法及其相应的诊断标准为金标准,对临床检验及高通量检测基因芯片测序技术的诊断效能进行分析。结果临床检测对COPD合并社区获得性肺炎病原体检测诊断效能:灵敏度=81.52%,特异度=63.89%,准确度=76.56%,阳性预测值=85.23%,阴性预测值=57.50%。高通量检测基因芯片测序对COPD并发社区获得性肺炎病原体检测诊断效能:灵敏度=91.43%,特异度=82.61%,准确度=89.84%,阳性预测值=96.00%,阴性预测值=82.61%。高通量检测灵敏度、特异度、准确度、阳性预测值、阴性预测值等诊断效能指标均明显高于临床检测(P<0.05)。高通量病原体检出阳性率明显高于临床检验(P<0.05),在肺炎链球菌及流感嗜血杆菌方面差异无统计学意义(P>0.05),在人腺病毒方面高通量病原体检出阳性率明显高于临床检验(P<0.05)。结论高通量检测基因芯片测序技术对COPD合并社区获得性肺炎病原体检测灵敏度、特异度、准确度、阳性预测值、阴性预测值等诊断效能指标均明显高于临床检测,该方法操作方便、诊断价值较高。
Objective To explore the feasibility of high-throughput detection of gene chip sequencing technology for chronic obstructive pulmonary disease(COPD)complicated with community-acquired pneumonia pathogen detection.Methods A total of 128 patients with suspected COPD complicated with community acquired pneumonia who were treated in our hospital from January 2017 to May 2018 were enrolled.All patients received qualified sputum specimens and alveolar lavage fluid samples before using antibiotics,and both pathogenic clinical tests and high-throughput sequencing were performed.The results of high-throughput sequencing were confirmed by PCR method and then based on Qualcomm.The sequencing method of chronic obstructive pulmonary disease combined with pneumonia pathogen detection method was evaluated.Referring to the“Chinese Adult Community Acquired Pneumonia Diagnostic and Treatment Guidelines(2016 Edition)”for the main detection methods of pathogens and their corresponding diagnostic criteria as the gold standard,the diagnostic efficacy of clinical testing and high-throughput detection of gene chip sequencing technology was analyzed.Results The sensitivity was 81.52%,the specificity was 63.89%,the accuracy was 76.56%,the positive predictive value was 85.23%,and the negative predictive value was 57.50%for clinical test.The sensitivity was 91.43%,the specificity was 82.61%,the accuracy was 89.84%,the positive predictive value was 96.00%,and the negative predictive value was 82.61%for high-throughput detection of gene chip sequencing. The diagnostic efficacy indicators such as sensitivity, specificity, accuracy, positive predictive value and negative predictive value of high-throughput detection were significantly better than clinical test ( P< 0.05). The positive rate of high-throughput pathogens was significantly higher than that of clinical test ( P< 0.05), and there was no significant difference in Streptococcus pneumoniae and Haemophilus influenzae ( P> 0.05). Conclusion The high-throughput detection gene chip sequencing technology has significantly higher diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for COPD complicated with community-acquired pneumonia pathogen detection. The method is convenient and diagnostic.
作者
方桂桔
张灿辉
刘志新
吴廷文
FANG Gui-ju;ZHANG Can-hui;LIU Zhi-xin;WU Ting-wen(Department of Respiratory Medicine,Ningde Hospital,Ningde,Fujian 352100,China)
出处
《临床肺科杂志》
2019年第9期1578-1581,共4页
Journal of Clinical Pulmonary Medicine
基金
福建省自然科学基金面上项目(No 2018J01228)
福建省宁德市科技局立项项目(No 20170100)
作者简介
通信作者:吴廷文,E-mail:1926427961@qq.com
