下一代测序技术在肺部感染病原体诊断中的应用价值

Value of next-generation sequencing in diagnosis of pulmonary pathogens

目的探讨下一代测序(next generation sequencing,NGS)技术在肺部感染患者病原体检测中的应用价值。方法纳入2018年3月至2019年12月郑州大学第一附属医院收治的90例疑诊肺部感染患者的临床资料,取所有患者的肺泡灌洗液分别送下一代测序、传统培养及G试验检测。检测或培养出病原体记录为阳性,否则为阴性,将不同检测方法的结果进行比对。结果病原体诊断中,NGS的灵敏度、特异度、阳性预测值、阴性预测值分别为82.35%、30.77%、60.87%、57.14%,传统培养法分别为40.00%、46.67%、42.86%、43.75%,诊断差异有统计学意义(P=0.000)。在真菌的诊断中,NGS技术与G试验均具有较高灵敏度、特异度及阴性预测值,诊断差异不具统计学意义(P=0.664)。结论在病原体诊断中,NGS技术较传统培养法具有更高的灵敏度及阳性预测值,尤其对罕见的病原体以及传统培养阴性的疑似肺部感染患者具有较高的应用价值;在真菌诊断中,NGS与G试验二者灵敏度均较高,同时用于真菌的检测将显著提高真菌识别度及病原体种类的鉴别水平。

Objective To explore the application value of next generation sequencing(NGS)technology in the detection of pathogens in patients with pulmonary infection.Methods The clinical data of 90 patients with suspected pulmonary infection admitted to our hospital from March 2018 to December 2019 were included.All the patients’BALF were sent to the next generation sequencing,traditional culture and G test detection.Detection or culture of pathogens recorded as positive,otherwise negative,the results of different detection methods were compared.Results In the diagnosis of pathogens,the sensitivity,specificity,positive predictive value and negative predictive value of NGS were 82.35%,30.77%,60.87%and 57.14%respectively,while those of traditional culture method were 40.00%,46.67%,42.86%and 43.75%,respectively.The difference was statistically significant(P=0.000).In the diagnosis of fungi,the sensitivity,specificity and negative predictive value of NGS technique and G test were high,and the difference was not statistically significant(P=0.664).Conclusion In pathogen diagnosis,NGS technology has higher sensitivity and positive predictive value than traditional culture method,especially for rare pathogens and suspected pulmonary infection patients with negative traditional culture;In fungal diagnosis,NGS and G test have high sensitivity,and the detection of fungi will significantly improve the identification of fungi and the level of pathogen identification.