宏基因组二代测序对肺部感染分枝杆菌的诊断价值

Value of metagenomic next-generation sequencing in the diagnosis of pulmonary mycobacterial infections

目的探讨肺泡灌洗液(BALF)行宏基因组二代测序技术(mNGS)检测在肺部感染病人分枝杆菌诊断中的应用价值。方法回顾性分析2021年10月—2023年4月在青岛大学附属医院呼吸科因肺部感染住院的281例病人临床资料和BALF病原体检出情况。结果281例BALF样本的检测阳性率为95.02%。共检测出105种微生物,其中副流感嗜血杆菌(45.20%)是最常见的检出菌种,其次为肺炎链球菌(44.48%)和假肺炎链球菌(32.38%);检测出分枝杆菌63例,总阳性率为22.42%,其中结核分枝杆菌复合群(MTBC)38例,鸟-胞分枝杆菌复合群(MAC)22例,堪萨斯分枝杆菌、慢生黄分枝杆菌和脓肿分枝杆菌各1例。MTBC的检测结果因年龄而异(χ^(2)=10.992,P<0.05);在MAC的检测中,性别差异明显(χ^(2)=9.483,P<0.01)。在MTBC和MAC分枝杆菌复合群阳性病人中,检测到的合并感染类型存在差异(χ^(2)=9.222,P<0.05)。结论mNGS可以提供快速的病原学诊断,在分枝杆菌的诊断方面具有潜力,有助于精准治疗。

Objective To investigate the application value of metagenomic next-generation sequencing(mNGS)of bronchoalveolar lavage fluid(BALF)in the diagnosis of mycobacteria in patients with pulmonary infections.Methods A retrospective analysis was performed for the clinical data and BALF pathogen detection results of 281 patients with pulmonary infection who were admitted to Department of Respiratory Medicine,The Affiliated Hospital of Qingdao University,from October 2021 to April 2023.Results The positive detection rate was 95.02%for the 281 BALF specimens.A total of 105 microorganisms were detected,among which Haemophilus influenzae(45.20%)was the most common bacterial pathogen,followed by Streptococcus pneumoniae(44.48%)and Streptococcus pseudopneumoniae(32.38%).Mycobacteria was detected in 63 specimens,with a total positive rate of 22.42%,among which there were 38 specimens of Mycobacterium tuberculosis complex(MTBC),22 specimens of Mycobacterium avium complex(MAC),and one specimen each of Mycobacterium kansasii,Mycobacterium lentiflavum,and Mycobacterium abscessus.The results of MTBC detection varied across ages(χ^(2)=10.992,P<0.05),and a significant gender difference was observed in MAC detection(χ^(2)=9.483,P<0.01).A significant difference in the type of co-infection was observed between the patients with positive MTBC and those with positive MAC(χ^(2)=9.222,P<0.05).Conclusion The mNGS technique can provide rapid pathogenic diagnosis and facilitate the diagnosis of mycobacteria and precise treatment.