环介导恒温扩增快速检测芯片在VAP中的应用价值

Clinical evaluation of a rapid 13-pathogen detecting loop-mediated isothermal amplification chip in ventilator-associated pneumonia patients

目的探讨环介导恒温扩增(LAMP)快速检测芯片在呼吸机相关性肺炎(VAP)中的应用价值。方法选择2019年10月至2021年6月在四川大学华西医院ICU诊断为VAP的患者155例,年龄(56.1±8.5)岁,男性患者100例(64.5%),急性生理学与慢性健康状况(APACHEⅡ)评分为20(15,25)分。根据是否进行LAMP检测分为LAMP组(80例)和传统培养组(75例)。比较2组病原菌检出情况、72 h内抗菌药物调整情况和临床结局。结果相较于传统培养组,LAMP组病原体检出时间明显缩短,差异有统计学意义[26(21,28)h vs 48(45,69)h,Z=8.075,P<0.001];经验性抗菌药物首次调整时间明显缩短,差异有统计学意义[32(26,47)h vs 48(41,50)h,Z=6.584,P=0.004];72 h内经验性抗菌药物调整比例明显升高,差异有统计学意义(42.5%vs 20.0%,χ2=20.675,P=0.003)。2组患者培养检出阳性率、72 h内抗菌药物使用恰当率、ICU住院时间及病死率比较,差异均无统计学意义(P>0.05)。结论LAMP检测方法相较于传统培养检出更快速,可直接影响抗菌药物选择,致使更多的患者在更早期调整经验性抗菌药物,可作为临床病原体检验方法的有效补充。

Objective To investigate the clinical value of a rapid 13-pathogen detecting loop-mediated isothermal amplification(LAMP)chip in ventilator-associated pneumonia patients.Methods A retrospective cohort study was conducted in intensive care unit(ICU),West China Hospital,Sichuan University from October 2019 to June 2021.155 patients diagnosed with ventilator-associated pneumonia,with age(56.1±8.5)years,100 male patients(64.5%),acute physiology and chronic health status(APACHEⅡ)score 20(15,25).They were grouped into LAMP or conventional group based on the usage of LAMP technique(80 in LAMP group and 75 in conventional group).Pathogens identification,antimicrobial therapy in 72 h and clinical outcome between these two groups were compared.Results Compared with the conventional group,the pathogen detection time of the LAMP group was significantly shorter,and the difference was statistically significant[26(21,28)h vs 48(45,69)h,Z=8.075,P<0.001];the adjustment time of the first empirical antimicrobial drugs was significantly shorter,and the difference was significant[32(26,47)h vs 48(41,50)h,Z=6.584,P=0.004];the proportion of empirical antimicrobial adjustments was higher significantly within 72 h with statistic significance(42.5%vs 20.0%,χ2=20.675,P=0.003).There were no significant differences in positive detected rate of in the culture,the appropriate antimicrobial use in 72 h,ICU stay and mortality rate(P>0.05).Conclusion Compared with conventional culture,LAMP test method can identify pathogens faster,and directly guide the adjustment of antibiotics.It can be used as an effective supplement to clinical test methods to guide clinical medication.