BALF病原微生物mNGS检测在难治性肺炎中的应用研究

Application of Detection of Pathogenic Microorganism in BALF by mNGS in Refractorily Treated Pneumonia

目的探讨支气管肺泡灌洗液(BALF)病原微生物宏基因组二代测序技术(mNGS)在难治性肺炎(RTP)患者中的应用效果。方法回顾分析2023年1月至2024年1月收治的60例行支气管镜BALF宏基因检测(mNGS组)和60例行传统培养(传统组)的RTP患者资料。对比mNGS组与传统组检出阳性率、病原菌、感染类型和治疗情况。结果mNGS组病原菌检出阳性率为95.00%(57/60)高于传统组的71.67%(43/60)(P<0.05)。mNGS组与传统组分别检出84株、57株病原菌。mNGS组革兰阴性菌、革兰阳性菌阳性检出率低于传统组,真菌、病毒、特殊病原体阳性检出率均高于传统组(P<0.05,P<001)。传统组单一感染检出率高于mNGS组(P<001),且以细菌感染为主。mNGS组混合感染检出率高于传统组(P<001),且以病毒-细菌感染、病毒-细菌-真菌感染为主。mNGS组抗菌药物使用时间、抗菌药物调整频次、住院时间、住院费用短于或低于传统组,总有效率高于传统组(P<0.05,P<001)。结论BALF病原微生物mNGS检测在RTP患者病原学诊断中有良好的应用效果,可以帮助临床医生早期识别病原体进而实施精准治疗,提高治疗总有效率,减少并发症。

Objective To investigate the application effect of detection of pathogenic microorganism in bronchoalveo-lar lavage fluid(BALF)by metagenomic next-generation sequencing technology(mNGS)in patients with refractorily treated pneumonia(RTP).Methods The data of 60 RTP patients who underwent bronchoscopic mNGS of BALF(mNGS group)and 60 RTP patients who underwent traditional culture(traditional group)from January 2023 to January 2024 were retrospec-tively analyzed.The positive rate,pathogen type,infection type and treatment were compared between mNGS group and tradi-tional group.Results The positive detection rate of pathogenic bacteria in mNGS group was 95.00%(57/60),which was higher than that of traditional group(71.67%,43/60)(P<0.05).In all,84 strains and 57 strains were detected in the mNGS group and the traditional group,respectively.The positive detection rates of gram-negative bacteria and gram-positive bacteria in mNGS group were lower than those in traditional group,while the positive detection rates of fungi,viruses and spe-cial pathogens in MNGS group were higher than those in traditional group(P<0.05,P<0.01).The detection rate of single infection in traditional group was higher than that in mNGS group(P<0.01),and bacterial infection was the main one.The detection rate of mixed infection in mNGS group was higher than that in traditional group(P<0.01),and virus-bacterial in-fection and virus-bacteria-fungal infection were the main ones.The duration of antibiotic use,frequency of antibiotic adjust-ment,length of hospital stay and hospitalization expenses in mNGS group were shorter or lower than those in traditional group,and the total effective rate was higher than that in traditional group(P<0.05,P<0.01).Conclusion Detection of patho-genic microorganism in BALF by mNGS has a good application effect in the etiological diagnosis of RTP patients,which can help clinicians identify pathogens early and then implement precise treatment,improve the total effective rate of treatment and reduce complications.