宏基因组二代测序技术在重症肺炎病原体检测中的诊断价值

Diagnostic value of metagenomic second-generation sequencing in detection of pathogens in severe pneumonia

目的探讨宏基因组二代测序(mNGS)技术在重症肺炎病原体检测中的诊断价值。方法回顾性选取2021年2月-2022年2月河西学院附属张掖人民医院收治的重症肺炎患者266例作为研究对象,2例因资料不齐全排除,共纳入264例患者进行研究。收集纳入对象的血标本和肺泡灌洗液,均行常规检测和mNGS检测。比较mNGS技术与常规检测方法检测血标本、肺泡灌洗液的结果,并对比mNGS技术与常规检测方法检测血标本、肺泡灌洗液中病原体的情况。结果mNGS技术检测血标本的阳性率为40.15%,高于常规检测方法的20.45%,差异有统计学意义(χ^(2)=24.248,P<0.05);mNGS技术检测肺泡灌洗液的阳性率为87.50%,高于常规检测方法的53.41%,差异有统计学意义(χ^(2)=73.697,P<0.05)。mNGS技术检测血标本中细菌的阳性率为27.27%,高于常规检测方法的11.36%,差异有统计学意义(χ^(2)=21.435,P<0.05);mNGS技术检测肺泡灌洗液中细菌、真菌、病毒的阳性率分别为46.59%、39.77%、25.38%,均高于常规检测方法的26.14%、19.70%、10.61%,差异均有统计学意义(χ^(2)=23.866、25.463、19.523,P均<0.05)。结论mNGS技术可有效提高重症肺炎患者的病原微生物检出率,可为重症肺炎的精准抗菌治疗提供病原学依据。

Objective To investigate the diagnostic value of metagenomic second-generation sequencing(mNGS)in detection of pathogens in severe pneumonia.Methods A total of 266 patients with severe pneumonia admitted to the Zhangye People's Hospital affiliated to the Hexi University from February 2021 to February 2022 were retrospectively selected as the study objects;2 patients were excluded due to incomplete data,and 264 patients were included in the study.Blood samples and broncho alveolar lavage fluid(BALF)were collected for routine detection and mNGS detection.The results of mNGS technique and routine detection method in detecting blood samples and bronchoalveolar lavage fluid were compared,and the detection of pathogens in blood samples and bronchoalveolar lavage fluid by mNGS technique and routine detection method were compared.Results The positive rate of mNGS was 40.15%,which was higher than that of routine method(20.45%),the difference was statistically significant(χ^(2)=24.248,P<0.05).The positive rate of mNGS in BALF was 87.50%,which was higher than that of routine method(53.41%),the difference was statistically significant(χ^(2)=73.697,P<0.05).The positive rate of mNGS was 27.27%,which was higher than that of routine method(11.36%),the difference was statistically significant(χ^(2)=21.435,P<0.05).The positive rates of bacteria,fungi and virus in BALF detected by mNGS were 46.59%,39.77%and 25.38%respectively,which were higher than those detected by routine method(26.14%,19.70%and 10.61%),the differences were statistically significant(χ^(2)=23.866,25.463,19.523,all P<0.05).Conclusion mNGS technology could effectively improve the detection rate of pathogenic microorganisms in patients with severe pneumonia and provide etiological basis for precise antibacterial treatment of severe pneumonia.