支气管肺泡灌洗液二代测序在肺部感染病原体检测中的应用价值

Application value of bronchoalveolar lavage fluid next-generation sequencing in the detection of pulmonary infection pathogens

目的研究支气管肺泡灌洗液(BALF)宏基因组学二代测序(mNGS)在肺部感染患者病原体检测中的临床价值。方法回顾性研究2021年4月至2023年12月合肥市第二人民医院呼吸与危重症医学科住院治疗的98例肺部感染的临床资料,患者均进行常规病原菌检测与BALF mNGS检测,对比两种检测方法BALF中病原菌检出率、确诊结果的一致性以及诊断效能。结果BALF中mNGS共检出细菌54例,真菌14例,病毒13例,支原体与衣原体各3例。BALF mNGS的细菌、真菌、病毒以及病原菌总检出率为88.78%,明显高于常规检验(25.51%),差异有统计学意义(P<0.05)。BALF中病原微生物mNGS检出结果与确诊结果的Kappa为0.795,一致性较高(P<0.001)。肺部感染患者病原微生物mNGS检测的敏感度与诊断符合率为95.92%,明显高于常规检验(28.57%),差异有统计学意义(P<0.05)。结论与常规病原菌检测方法相比,通过对BALF应用mNGS检测,明显提升了细菌、真菌、病毒、支原体和衣原体等微生物的检出率,而且能识别出更多种类的微生物。mNGS技术在诊断肺部感染中显示出高敏感度和诊断符合率。

Objective To investigate the clinical value of bronchoalveolar lavage fluid(BALF)metagenomic next-generation sequencing(mNGS)in pathogen detection of patients with pulmonary infection.Methods The clinical data of 98 cases of pulmonary infection hospitalized in the Department of Respiratory and Critical Care Medicine of the Second People's Hospital of Hefei from April 2021 to December 2023 were retrospectively studied.All patients underwent routine pathogen detection and BALF mNGS detection.The detection rate of pathogenic bacteria,the consistency of diagnosis results and the diagnostic efficacy of the two methods in BALF were compared.Results A total of 54 bacteria,14 fungi,13 viruses,3 mycoplasma and 3 chlamydia were detected in bronchoalveolar lavage fluid with mNGS in BALF.The total detection rate of bacteria,fungi,viruses and pathogens of mNGS in bronchoalveolar lavage fluid was 88.78%,which was significantly increased compared with conventional test(25.51%),the difference was statistically significant(P<0.05).The Kappa between the detection results of pathogenic microorganisms mNGS in BALF and the confirmed results was 0.795,with a high consistency(P<0.001).The sensitivity and diagnostic load rate of pathogenic microorganism mNGS in pulmonary infection patients was 95.92%,which was significantly higher than that of routine examination(28.57%),the difference was statistically significant(P<0.05).Conclusion Compared with conventional pathogen detection methods,the application of mNGS detection in BALF significantly improves the detection rate of microorganisms such as bacteria,fungi,viruses,mycoplasma,and chlamydia,and can identify more types of microorganisms.MNGS technology has shown high sensitivity and diagnostic accuracy in diagnosing pulmonary infections.