社区获得性肺炎病原学检测新进展

Research advance in etiological diagnosis of community-acquired pneumonia

成人社区获得性肺炎(community-acquired pneumonia,CAP)是全球高发病率、高死亡率的疾病之一。明确CAP的致病微生物能够指导最佳的抗感染治疗策略,改善患者预后,且具有重要的流行病学及公共卫生学价值。传统微生物学检测方法如微生物培养、尿病原体抗原检测等简便、普及性高,但受时效性、敏感性、标本运输处理、分离培养条件等多方面的限制。近年来微生物核酸分子检测技术快速发展,基于聚合酶链式反应(polymerasechain reaction,PCR)的核酸分子扩增检测能够快速定量检测目标病原体基因片段,敏感性、特异性高。二代测序技术为呼吸道微生物检测带来了重大变革,能同时测定许多病原体的保守基因序列,使对呼吸道微生物群落的研究达到前所未有的广度和深度。传统检测方法的继续改良与核酸分子检测手段的不断创新,多种检测手段的优化组合,将为临床CAP的诊断提供更全面准确的病原学信息。同时,下呼吸道微生物组学的研究有望揭示CAP发生发展与呼吸道微生物组变化的关系,使CAP的临床诊疗进入新的时代。

Community-acquired pneumonia （CAP） is one of the worldwide diseases with high morbidity and mortality worldwide. To identify the pathogenic microorganisms for CAP can provide the best therapeutic strategies of antimicrobial agents ; improve the outcome of patients, with great importance for epidemiology monitor and public health planning. Tra- ditional microbiological techniques such as microbiological culture and urinary antigen tests are simple and convenient, but limited by its imperfection in timeliness and sensitivity, which prone to be affected by sample management and cultur- al conditions. Microbial nucleic acid detection got rapidly development in recent years. The nucleic acid amplification tests （polymerase chain reaction, PCR） can identify pathogenic genetic materials quickly with high sensitivity and speci- ficity. Next-generation sequencing had revolutionized the identification of microbes in respiratory tract, which detects con- served gene sequence of multiple pathogens simultaneously, and provides unprecedented depth and width for respiratory microbiome analysis. The improvement of traditional microbiological methods and advance in nucleic acid detection meth- ods, as well as optimal combination of multiple techniques will provide comprehensive and accurate pathogenic informa- tion for CAP diagnosis. In addition, the investigation on the characteristics of microbiome makes promise to reveal the re- lation between CAP and dysbiosis of microbiome in lower respiratory tracts, and brings novel insights for better manage- ment of CAP patients.