支气管肺泡灌洗液二代宏基因测序在肺部感染病原学诊断中的应用

Application of metagenomics next-generation sequencing of bronchoalveolar lavage fluid in etiological diagnosis of pulmonary infection

目的探讨支气管肺泡灌洗液二代宏基因测序在肺部感染病原学诊断中的应用。方法选取淄博市第一医院2020年1月至2022年1月收治的80例肺部感染患者作为研究对象,通过病历号数字表抽签法将患者分为观察组(n=40)和对照组(n=40)。患者均接受支气管肺泡灌洗液检查,观察组在此基础上给予肺泡灌洗液二代宏基因测序检查。比较两组患者的支气管肺泡灌洗液病原菌分布情况、病原菌检出率以及治疗后的临床指标。结果本次80例肺部感染患者的肺泡灌洗液中共分离并获得96株病原菌。其中革兰氏阳性菌总共20株,占20.83%,其中以肺炎链球菌和金色葡萄球菌为主;革兰阴性菌总共72株,占75.00%,主要以鲍曼不动杆菌、铜绿假单胞菌和流感嗜血杆菌为主;真菌总共3株,占3.12%,以白色念珠菌为主;对照组40例患者,通过常规病原菌检测结果检出阳性28例,占70.00%;观察组40例患者,通过二代宏基因测序结果检出阳性37例,占92.50%,相较于对照组,观察组检出率显著更高(P<0.05);相较于对照组,观察组患者30 d内和90 d内病死率均显著更低(P<0.05)。结论支气管肺泡灌洗液二代宏基因测序在肺部感染病原学诊断中的运用价值高,可有效提高检出率,可帮助临床上给予对应治疗。

Objective To investigate the application of metagenomics next-generation sequencing of bronchoalveolar lavage fluid in the etiological diagnosis of pulmonary infection.Methods A total of 80 patients with pulmonary infection admitted to Zibo First Hospital from January 2020 to January 2022 were selected as the research object and divided into the observation group(n=40)and the control group(n=40)by drawing lots from the digital table of medical records.All patients underwent the examination of bronchoalveolar lavage fluid,and the observation group was given the metagenomics next-generation sequencing of bronchoalveolar lavage fluid on this basis.The distribution of pathogens in bronchoalveolar lavage fluid,the detection rate of pathogens and the clinical indicators after treatment were compared between the two groups.Results A total of 96 strains of pathogenic bacteria were isolated from the alveolar lavage fluid of 80 patients with pulmonary infection.Thereinto,there were 20 strains of gram-positive bacteria,accounting for 20.83%,mainly Streptococcus pneumoniae and Staphylococcus aureus;there were 72 strains of gram-negative bacteria,accounting for 75.00%,mainly Acinetobacter baumannii,Pseudomonas aeruginosa and Haemophilus influenzae;there were 3 strains of fungi,accounting for 3.12%,mainly Candida albicans.Of the 40 patients in the control group,28 were positive by routine pathogenic bacteria detection,accounting for 70.00%,of the 40 patients in the observation group,37 were positive by metagenomics next-generation sequencing,accounting for 92.50%,which was significantly higher than that in the control group(P<0.05).The 30-day and 90-day mortalities in the observation group were significantly lower than those in the control group(P<0.05).Conclusion The metagenomics next-generation sequencing of bronchoalveolar lavage fluid is of great value in the etiological diagnosis of pulmonary infection,which can effectively increase the detection rate and help to give corresponding treatment in clinic.