宏基因二代测序技术在肺部阴影发热病例诊断中的应用价值

Application value of Acer second generation sequencing in diagnosis of patients with lung shadow fever

目的探讨支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)病原宏基因二代测序(metagenomic next-generation sequencing,mNGS)技术在肺部阴影发热病例诊断中的价值。方法回顾性分析我科收治的94例病例,均收集BALF同时行病原mNGS及传统检测(微生物培养+涂片镜检),比较两种方法诊断效能,并分析mNGS结果的影响因素。结果以最终诊断为准,mNGS与传统检测比较:病原阳性率76.6%vs 19.1%、灵敏度83.5%vs 20.3%、阴性预测值40.9%vs 17.1%、诊断符合率79.8%vs 30.9%、混合感染检出率45.6%vs 7.6%,mNGS组明显优于传统组(P<0.05);且mNGS检出病原种类、数量及时间有明显优势。经二元Logistic分析基础疾病数量、发热可能是mNGS阳性结果的影响因素;检测公司及抗生素使用时间影响较小。结论与传统检测相比,BALF的病原mNGS检测高效快速,有助于肺部阴影发热病例诊断和鉴别诊断。

Objective To explore the value of bronchoalveolar lavage fluid(BALF)pathogen metagenomic next generation sequencing(mNGS)in diagnosis of pulmonary shadow fever.Methods Retrospective analysis was performed on 94 cases admitted to our department.All BALFs were collected and treated with pathogenic mNGS and traditional detection(microbial culture+smear microscopy).The diagnostic efficacy of the two methods was compared,and the influencing factors of the results of mNGS were analyzed.Results Based on the final diagnosis,mNGS was compared with traditional detection:Positive rate of pathogen 76.6%vs 19.1%,sensitivity 83.5%vs 20.3%,negative predictive value 40.9%vs 17.1%,diagnostic coincidence rate 79.8%vs 30.9%,the detection rate of mixed infection 45.6%vs 7.6%,mNGS group was significantly better than traditional group(P<0.05).NGS had obvious advantages in the type,quantity,and time of pathogen detection.By binary logistic analysis,the number of underlying diseases and fever might be the influencing factors of positive mNGS results;Test company and antibiotic use time had little effect.Conclusion Compared with traditional detection,BALF pathogen mNGS detection is efficient and rapid,which is helpful for the diagnosis and differential diagnosis of lung shadow fever cases.