基因芯片技术在成人下呼吸道感染病原学检测中的临床应用及评价

Clinical application and evaluation of gene chip technology in the pathogen detection of adult lower respiratory tract infection

目的调查了解成人下呼吸道感染的病原谱,评价基因芯片检测技术在成人下呼吸道感染病学检测中的临床应用价值。方法留取因下呼吸道感染住院的成人患者下呼吸道标本,分别进行常规培养及29种病原体基因芯片法检测,并对检测结果进行统计分析。结果共入组451例患者,A组(18~45岁)63例,B组(45~60岁)95例,C组(>60岁)293例;基因芯片法病毒的总检出率为77.61%,C组较高,但差异无统计学意义(χ~2=4.97,P>0.05)。基因芯片法细菌的总检出率为59.20%,阳性菌以肺炎链球菌为主,A组患者检出率较高,但差异无统计学意义(χ~2=1.38,P>0.05);阴性菌以流感嗜血杆菌及鲍曼不动杆菌为主,流感嗜血杆菌在B组患者检出率较高,但差异无统计学意义(χ~2=5.73,P>0.05),非发酵菌在C组患者检出率较高,但差异无统计学意义(χ~2=4.72,P>0.05),肠杆菌科细菌在C组患者检出率较高,差异有统计学意义(χ~2=9.83,P<0.05)。基因芯片法白色念珠菌的总检出率为28.60%, C组较高,差异有统计学意义(χ~2=7.06,P<0.05)。基因芯片检测与流感病毒感染临床诊断对比,总符合率为80.93%,敏感度18.75%,特异度94.34%,阳性预测值41.67%,阴性预测值84.34%;与传统细菌培养结果对比,总符合率为83.59%,敏感度50.45%,特异度94.41%,阳性预测值74.67%。结论病毒检出率较高,阳性菌以肺炎链球菌为主,阴性菌以流感嗜血杆菌及鲍曼不动杆菌为主,不典型病原体较少见;病毒、阴性菌及真菌在>60岁患者检出率较高;与传统培养法及流感临床拟诊相比,基因芯片检测技术有较高的符合率、特异度及阴性预测值。

Objective To investigate the pathogenic spectrum of adult lower respiratory tract infection in our hospital, and to evaluate the clinical application of gene chip detection technology in the detection of adult lower respiratory tract infection. Methods The lower respiratory tract specimens of adult patients hospitalized for lower respiratory tract infection were taken for routine culture and 29 pathogen gene chip assays, The lower respiratory tract specimens of adult patients hospitalized for lower respiratory tract infection were routinely cultured and detected by 29-pathogen gene chip methods. The results were statistically analyzed. Results A total of 451 patients were enrolled, including 63 patients in Group A(18-45 years old), 95 patients in Group B(45-60 years old), and 293 patients in Group C(>60 years old). The total detection rate of virus with gene chip was 77.61%, it was higher in Group C(χ~2= 4.97, P>0.05). The total detection rate of bacteria with gene chip was 59.20%. The detected bacteria was mainly S.pneumoniae, and the detection rate in Group A was higher(χ~2=1.38, P>0.05). The negative bacteria were mainly Haemophilus influenzae and Acinetobacter baumannii. The detection rate of Haemophilus influenzae in Group B was higher(χ~2=5.73, P>0.05). Non-fermentative bacteria and Enterobacteriaceae had higher detection rates in Group C(χ~2=4.72, P>0.05;χ~2=9.83, P<0.05). The total detection rate of Candida albicans by gene chip method was 28.60%, which was higher in Group C(χ~2=7.06, P<0.05). Compared with the clinical diagnosis of influenza virus, the total coincidence rate was 80.93%, the sensitivity was 18.75%, the specificity was 94.34%, the positive predictive value was 41.67%, and the negative predictive value was 84.34%. Compared with the traditional bacterial culture results, the total coincidence rate was 83.59%, the sensitivity was 50.45%, the specificity was 94.41%, and the positive predictive value was 74.67%. Conclusion The detection rate of virus is high. The positive bacteria are mainly Streptococcus pneumoniae. The negative bacteria are mainly Haemophilus influenzae and Acinetobacter baumannii. Atypical pathogens are rare. Virus, negative bacteria and fungi are more often detected in Group C. Compared with traditional culture method and clinical diagnosis of influenza, gene chip detection technology is with higher coincidence rate, specificity and negative predictive value.