二代基因测序在重症肺炎早期致病菌诊断中的价值研究

The value of second-generation gene sequencing in the determination of early causative agents in severe pneumonia

目的探讨二代基因测序(mNGS)在重症肺炎(SP)早期致病菌诊断中的价值。方法选取32例SP患者,收集患者一般临床资料、实验室检查相关资料、胸部影像学资料、28 d病死率和ICU住院时间。结果A组检测结果回报需要(23.65±3.20)h,B组检测结果回报需要(117.46±16.32)h。A组耗时显著短于B组(P<0.05);A组的敏感性高于B组(P<0.05),而其特异性低于B组(P<0.05)。A组的阳性预测值为88.97%、阴性预测值为58.97%,B组的阳性预测值为98.72%、阴性预测值为76.09%;有26例患者根据早期mNGS结果,结合患者体温、炎性指标在经验性抗感染治疗基础上调整了抗生素治疗策略,改变用药方案后,其中有21例患者病情好转,有5例患者死亡。纳入的32例患者中死亡7例,28 d病死率为21.9%。结论mNGS对于SP早期致病菌的诊断具有一定的临床价值,可提高SP的诊断准确性和诊断速度。

Objective To investigate the value of second-generation gene sequencing technology(mNGS)in the determination of early causative organisms in severe pneumonia.Methods Selected 32 patients,General clinical data,laboratory tests,pulmonary imaging data,28-day survival rate and ICU treatment time.Results The test results return in group A took(23.65±3.20)hours and in group B it took(117.46±16.32)hours.Group A took significantly less time than group B(P<0.05);Group A had higher sensitivity than group B(P<0.05),while specificity was lower than group B(P<0.05).The positive predictive value in group A was 88.97%and the negative predictive value was 58.97%,while the positive predictive value in group B was 98.72%and the negative predictive value was 76.09%;26 patients adjusted their antibiotic treatment strategy based on empirical anti-infection treatment according to the early mNGS results,combined with the patient′s temperature and inflammatory index,and 21 of them improved after changing the medication regimen,5 patients died.Of the 32 patients registered,7 died,and the 28-day mortality rate was 21.9%.Conclusion mNGS is clinically valuable for the diagnosis of early causative organisms in severe pneumonia and it can improve the diagnostic accuracy and rapidity of this disease.