不同方法检测支气管扩张患者下呼吸道病原体的评价

Assessment of different diagnostic tests in identification of bacterial pathogens in lower respiratory tract of bronchiectasis patients

目的分析传统培养法和实时荧光定量PCR法对下呼吸道病原体的检测效果。方法以本院住院的65例支气管扩张伴感染患者作为研究对象,获得支气管肺泡灌洗液(BALF)和防污染毛刷(PSB)标本,分别采用传统培养法和实时荧光定量PCR法检测常见下呼吸道病原菌,对所得检测结果进行比较分析。结果 PSB标本培养法检测阴性率为36.9%,明显高于BALF检测阴性率(23.1%),差异有统计学意义(P<0.01)。荧光定量PCR分析PSB标本检测阴性率为7.7%,各菌种检测阳性率均明显高于培养法,差异有统计学差异(P<0.01),且肺炎克雷伯杆菌和铜绿假单胞菌的拷贝数明显高于另4种菌株,差异有统计学意义(P<0.05)。结论在支气管扩张合并感染患者中,PSB标本检测特异性更高;荧光定量PCR方法检测迅速,具有更高的敏感性,对抗菌药物早期正确应用具有重要的指导意义。

Objective To assess the diagnosis value of traditional culture method and the real-time fluorescent quantitative PCR（RT-q PCR） method in identification of bacterial pathogens in lower respiratory tract.Methods 65 bronchiectasis patients associated with infection in Yinzhou People＇s Hospital have been enrolled.Both traditional culture and RT-q PCR methods were performed for the samples of bronchoalveolar lavage fluid（BALF） and protected specimen brush（PSB） obtained by bronchoscope,and the results were analyzed.Results The negative rate of traditional culture detection in PSB samples was36.9%,which was significantly higher than the negative rate in BALF samples（23.1%）,with the differences statistically significant（P〈0.01）.The total positive rate of fluorescence quantitative PCR analysis in PSB samples was 7.7%.And the positive rate of RT-q PCR in each strain was significantly higher than that of traditional culture detection,with the differences statistically significant（P〈0.01）.Klebsiella pneumonia and Pseudomonas aeruginosa had higher copies than the other four stains,with the differences statistically significant（P〈 0.05）.Conclusion In patients with bronchiectasis complicated with infection,the detection specificity of PSB was higher; fluorescence quantitative PCR is rapider and more sensitive,which has important guiding significance for the early application of antibiotics.