肺泡灌洗液病原微生物宏基因检测在儿童重症肺炎治疗中的临床应用分析

An Analysis of Clinical Applications of Detection of Pathogenic Microbial Metagenes in Alveolar Lavage Fluid in the Treatment of Severe Pneumonia in Children

目的探讨肺泡灌洗液病原微生物宏基因检测(mNGS)在儿童重症肺炎治疗中的应用价值。方法回顾分析2018年12月至2020年12月我院儿科PICU收治的重症肺炎并送检肺泡灌洗液病原学微生物mNGS检测的患儿120例,收集患儿的一般临床资料,分别采用传统检测方法以及mNGS报告判断患儿病原体类型。以临床综合判断(采用肺泡灌洗液、痰液、血液等结合评估)为金标准,评估mNGS、传统微生物学报告与临床判断的符合率。分析mNGS检测后患儿的治疗调整情况,观察治疗效果。结果在120例患者中,经传统检测提示病毒、G^(+)菌、G^(-)菌、真菌、支原体、衣原体分别为8例、7例、11例、1例、9例、2例(其中有5例混合感染)。经mNGS检测提示病毒、G^(+)菌、G^(-)菌、真菌、支原体、衣原体分别为27例、9例、17例、1例、49例、5例(其中有11例混合感染)。临床综合判断提示,病毒、G^(+)菌、G^(-)菌、真菌、支原体、衣原体分别为28例、9例、16例、1例、42例、4例(其中有10例混合感染)。mNGS检出阳性率显著高于传统检测结果(80.83%vs 27.50%,P<0.01)。与临床综合判定相比,mNGS符合率亦显著高于传统检测结果(80.00%vs 18.89%,P<0.01)。有29例患儿根据mNGS结果调整治疗,其中21例调整治疗后,临床症状明显改善。结论重症肺炎患儿应用肺泡灌洗液病原学微生物mNGS检测,可提高病原检出阳性率,且能对治疗方案进行调整,促进预后改善。

Objective To explore the application value of the detection of metagenomic next-generation sequencing(mNGS)of alveolar lavage fluid in the treatment of severe pneumonia in children.Methods A retrospective analysis was conducted for 120 children with severe pneumonia admitted to the Pediatric PICU of our hospital from December,2018 to December,2020 and were sent for examination for the detection of pathogenic microorganism mNGS in alveolar lavage fluid.We collected the general clinical data of these children,and used traditional detection methods and mNGS reports to determine the type of pathogens.The comprehensive clinical judgment(combined evaluation of alveolar lavage fluid,sputum,blood,etc.)was applied as the gold standard to evaluate the coincidence rate of mNGS,traditional microbiology reports and clinical judgment.We then analyzed the treatment adjustment of children after mNGS detection and observed the treatment effect.Results Of the 120 patients,traditional tests indicated that the virus,G^(+)bacteria,G^(-)bacteria,fungi,mycoplasma,and chlamydia were 8 cases,7 cases,11 cases,1 case,9 cases,and 2 cases(of which 5 cases were mixed infections),respectively.The detection of mNGS showed that there were 27 cases,9 cases,17 cases,1 case,49 cases,and 5 cases of virus,G^(+)bacteria,G^(-)bacteria,fungi,Mycoplasma,and Chlamydia(including 11 mixed infections),respectively.Comprehensive clinical judgment indicated that there were 28 cases,9 cases,16 cases,1 case,42 cases,and 4 cases of virus,G^(+)bacteria,G^(-)bacteria,fungi,mycoplasma,and chlamydia(including 10 mixed infections),respectively.The positive rate of mNGS detection was significantly higher than the traditional test results(80.83%vs 27.50%,P<0.01).Compared with the comprehensive clinical judgment,the coincidence rate of mNGS was also significantly higher than that of traditional test results(80.00%vs 18.89%,P<0.01).Twenty-nine patients were adjusted for their treatment plan according to the results of mNGS,and 21 of them improved their clinical symptoms significantly.Conclusion The application of alveolar lavage fluid pathogenic microorganism mNGS detection in children with severe pneumonia can increase the positive rate of pathogen detection,and can also facilitate the adjustment of the treatment plan to promote prognosis.