呼吸道病原体核酸检测在稳定期矽肺患者中的应用价值

Application value of nucleic acid detection of respiratory pathogens in patients with stable silicosis

目的探讨呼吸道病原体核酸检测(Nucleic acid detection of respiratory pathogens,NADRP)在稳定期矽肺患者中的应用价值。方法采集2018年1月—2019年12月在徐州医科大学第二附属医院呼吸与危重症医学科及尘肺科收治的60例矽肺(Ⅰ期矽肺28例,Ⅱ期矽肺25例,Ⅲ期矽肺7例)患者合格痰标本300份行NADRP;采集300份行痰培养,了解不同矽肺分期及合并症患者的呼吸道病原体。结果采用NADRP阳性标本数为245份,总阳性率为81.67%。检出率最高病原体分别为:Ⅰ期矽肺84.29%,耐甲氧西林金黄色葡萄球菌(Methicillin-resistant staphylococcus,MRS)占35.7%;Ⅱ期矽肺81.6%,流感嗜血杆菌(Haemophilus influenzae,HIN)占32%;Ⅲ期矽肺71.43%,铜绿假单胞菌(Pseudomonas aeruginosa,PA)占25.71%。合并慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)者28例,发病率为46.67%,MRS检出数最高;合并分枝杆菌感染者6例,陈旧性肺结核3例,结核分枝杆菌复合群(Mycobacterium tuberculosis complex,MTBC)阳性导致肺结核确诊2例,痰涂片抗酸染色阳性1例,发病率10%,HIN最常见;肺癌/肺占位患者6例,发病率10%,MRS及PA阳性率最高;支气管扩张患者3例,占5%,PA检出数居首位。痰培养阳性率为21%,最高的是PA,为5.33%,其次为大肠埃希菌(Escherichia coli,E.Coli),为4.33%。NADRP与痰培养的阳性率比较提示结果差异具有统计学意义(P<0.05)。结论在不同分期的稳定期矽肺患者中,NADRP可有效、快速地检出多种病原体,是了解矽肺进展及判断治疗决策的有效方式。

Objective To explore the application value of NADRP in patients with stable silicosis.Methods Sixty patients with stable silicosis were included in this study,including 28 cases of stage I silicosis,25 cases of stage II silicosis and 7 cases of stage III silicosis.There were 300 qualified sputum samples collected for NADRP and sputum cultivation to detect the respiratory pathogens in different silicotic stages and complications.Results Totally 245 positive samples were detected by NADRP and the total positive rate was 81.67%.The positive rate in patients of stage I silicosis was 84.29%and MRS reached up to 35.7%as the most frequent detected pathogen.The detection rate in stage II silicosis was 81.6%and HIN ranked the top with the percentage of 32%.In patients with stage III silicosis,the positive percentage was 71.43%and PA became the highest positive bacteria with its detection rate of 25.71%.The cases with COPD were 28 with incidence rate of MRS account for 46.67%.The tuberculosis incidence rate was 10%,in which two of them were confirmed by NADRP,and 1 case had positive acid-fast staining of sputum smears.Lung cancer/lung occupying had 6 cases(10%),and MRS and PA positive rate was the highest.3 cases of bronchiectasis accounting for 5%and PA was the top pathogen.The positive rate of sputum culture was 21%and the most common pathogen was identified to be PA(5.33%),followed by E.coli(4.33%).The positive rate of NADRP and sputum culture showed that the difference was statistically significant(P<0.05).Conclusion In different stages of stable silicosis patients,NADRP can effectively and quickly detect a variety of pathogens,which is an effective way to understand the progress of silicosis and judge the treatment decision.