宏基因组二代测序技术在重症肺炎病原学诊断中的应用价值

Application value of metagenomic next generation sequencing technology in etiological diagnosis of severe pneumonia

目的探讨宏基因组二代测序技术(mNGS)在重症肺炎病原学诊断中的应用价值。方法纳入2020年1月至2021年12月在海军安庆医院就诊并确诊为重症肺炎的65例患者作为研究对象,收集患者的支气管肺泡灌洗液(BALF)和血标本,行mNGS检测和常规微生物检测。结果无论是BALF还是血标本,mNGS检测病原微生物的阳性率均显著高于常规检测方式(P<0.05)。相较于常规检测方法,BALF中mNGS检出细菌、真菌和病毒的阳性率均显著升高(P均<0.05);血标本中mNGS检出细菌的阳性率显著高于常规检测方法(P<0.05),但mNGS检出真菌的阳性率与常规检测方法比较差异无统计学意义(P>0.05)。采用mNGS方法检测BALF病原微生物的阳性率显著高于血样本的阳性率(P<0.05)。有27例患者根据mNGS检测结果调整了抗感染治疗方案,最终19例患者好转后出院。结论对重症肺炎患者应用mNGS方法检测,可提高病原微生物的检出阳性率,为重症肺炎精准抗感染治疗提供病原学依据,并指导临床医生调整抗感染治疗方案。

Objective This study aims to explore the application value of metagenomic next-generation sequencing inetiological diagnosis of severe pneumonia patients.Methods 65 patients diagnosed with severe pneumonia inhospital from January 2020 to December 2021 were selected as the study subjects.Bronchoalveolar lavage fluid(BALF)and blood samples were collected,and mNGS and conventional microbial tests were performed.Results The positive rate of mNGS was significantly higher than that of conventional detection in BALF and bloodsamples(P<0.05).The positive rates of bacteria,fungi and viruses detected by mNGS in BALF were significantly higher than those detected by conventional methods(P<0.05).The positive rate of bacteria detected by mNGS in blood samples was significantly higher than that by conventional detection method(P<0.05),while there was no statistical significance in the positive rate of fungi detected by mNGS compared with conventional detection method(P>0.05).The positive rate of BALF detected by mNGS was significantly higher than that of blood samples(P<0.05).27 patients adj-usted the anti-infective regimen based on mNGS test results,and 19 patients were eventually discharged after the improvement.Conclusion mNGS method can improve the positive rate of pathogen detection in patients with severe pneumonia,it provides etiological basis for precise anti-infection treatment of severe pneumoniaand guides clinicians to adjust anti-infection treatment plan.