支气管肺泡灌洗液mNGS在79例疑诊社区获得性肺炎患者病原学诊断中的应用

The application of Bronchoalveolar lavage fluid mNGS in the pathogenetic diagnosis of 79 patients with community-acquired pneumonia

目的分析支气管肺泡灌洗液(BALF)宏基因二代测序技术(mNGS)在社区获得性肺炎患者病原学检测中的应用价值。方法采用回顾性分析遵义医科大学附属医院2019年11月7日至2022年10月10日住院治疗的79例疑诊社区获得性肺炎患者的临床资料;比较BALFmNGS检测和传统病原体培养方法对病原体检出的阳性率、病原学分布,和不同特征患者BALFmNGS的阳性检出率、病原学不同检测方法结果的一致性及3种方法诊断社区获得性肺炎(CAP)的效能。结果mNGS检出BALF病原体阳性率(81.01%)显著高于传统病原体培养方法(32.91%,χ^(2)=3.214,P<0.05),其中BALFmNGS检测结果中肺炎链球菌、流感嗜血杆菌、新生隐球菌、黄曲霉菌阳性率显著高于传统病原体培养方法(P<0.05);在不同特征患者mNGS检出BALF病原体阳性率比较中,仅影像学提示肺炎有统计学意义(P<0.05),其中影像学提示肺炎的患者病原体检出率(73.42%)高于无肺炎检出率(26.58%)。BALFmNGS和传统检测的灵敏度分别为87%、17%,特异度分别为43%、6%,两者联合对CAP患者诊断ROC曲线下面积为0.867,灵敏度98%,特异度75%。结论BALFmNGS检测可提高CAP病原学检测阳性率,是检测病原体的重要补充方法。此外,BALFmNGS检测联合传统培养可有效提高对CAP的诊断效能。

Objective To analyze the application value of bronchoalveolar lavage fluid(BALF)metagenomic next-generation sequencing(mNGS)technology in the pathogenic detection of patients with community-acquired pneumonia.Methods Retrospective analysis of the clinical data of 79 patients with suspected community-acquired pneumoniahospitalized,from November 7,2019 to October 10,2022,in Affiliated Hospital of Zunyi Medical University,all of whom received bronchoalveolar lavage fluid mNGS testing and traditional pathogen culture methods,was conducted.The positive detection rate of pathogen detection,pathogenic distribution,positive detection rate of bronchoalveolar lavage fluid mNGS in patients with different characteristics,as well as the consistency of the results of the different pathogen detection methods in pathogenesis between the two testing methods and the three methods to diagnose the effectiveness of CAP were compareed.Results The positive rate of pathogens detected by mNGS in bronchoalveolar lavage fluid(81.01%)was significantly higher than that of the conventional pathogen culture method(32.91%,χ^(2)=3.214,P<0.05).The positive rates of Streptococcus pneumoniae,Haemophilusinfluenzae,Cryptococcus neoformans and Aspergillus flavus were significantly higher than those of conventional pathogen culture methods(P<0.05).Comparison of positive rate for BALF pathogens detected by mNGS in patients with different characteristics,imaging suggestive of pneumonia was found to be statistically significant(P<0.05),in which there was a higher pathogen detection rate in patients with imaging suggestive of pneumonia(73.42%)than in those without pneumonia(26.58%).The sensitivity of mNGS in bronchoalveolar lavage fluid and the traditional detection method were 87%and 17%,and the specificity was 43%and 6%,respectively.The area under the ROC curve for the diagnosis of CAP patients with the combination of the two was 0.867,with sensitivity(98%)and the specificity(75%).Co nclusion The BALFmNGS test improves the pathogenicity of CAP and can be a valuable complementary method for pathogen detection.Moreover,BALFmNGS combined with traditional detection method can effectively improve the diagnostic efficacy of CAP.