LAMP十三联检在COPD合并社区获得性肺炎患者中的应用价值

The clinical value of loop-mediated isothermal amplification in the patients with chronic obstructive pulmonary disease combined with community-acquired pneumonia

目的探讨环介导等温扩增技术(LAMP)十三联检在慢性阻塞性肺疾病(COPD)合并社区获得性肺炎(CAP)患者中的应用价值。方法回顾性分析2020年8月1日-2022年11月31日在西南医科大学附属医院呼吸与危重症医学科住院的COPD合并社区获得性肺炎患者343例,收集患者基本资料,留取患者入院后合格痰液标本,同时行痰细菌培养、LAMP十三联检,了解病原菌分布,并对比两种方法差异性及一致性。结果LAMP十三联检阳性率为49.85%,痰培养阳性率为20.99%,两种方法差异有统计学意义(χ^(2)=13.989,P<0.001)。一致性检验提示大肠埃希菌(Eco)一致性最好(Kappa值为0.796),鲍曼不动杆菌(Aba)、铜绿假单胞菌(Pae)、肺炎克雷伯菌(Kpn)、金黄色葡萄球菌(Sau)、耐甲氧西林葡萄球菌(Mrs)和嗜麦芽窄食单胞菌(Sm)Kappa值均>0.4,具有一致性,而流感嗜血杆菌(Hi)Kappa值仅为0.174,一致性差。COPD病程<10年组和≥10年组检出病原菌在Pae、单一感染和总阳性率差异有统计学意义(P<0.05);呼吸衰竭组和非呼吸衰竭组在Pae、单一感染、总阳性率差异有统计学意义(P<0.001)。结论LAMP十三联检能够快速、准确的识别病原体,有助于慢性阻塞性肺疾病合并社区获得性肺炎患者病原体的早期识别,对患者诊断与治疗有一定指导意义。

Objective To investigate the clinical value of loop-mediated isothermal amplification(LAMP)in the patients with chronic obstructive pulmonary disease combined with community-acquired pneumonia.Methods A total of 343 patients with chronic obstructive pulmonary disease combined with community-acquired pneumonia admitted to the department of respiratory and critical care medicine of the Affiliated Hospital of Southwestern Medical University from August 1,2020 to November 31,2022 were retrospectively analyzed.The basic information of patients was collected.Further,the sputum samples were collected from patients for bacterial culture and LAMP simultaneously.Results The difference was especially notable between the positive rate of LAMP(49.85%)and the sputum culture(20.99%)(χ^(2)=13.989,P<0.001).The Kappa test showed that Escherichia coli(Eco)were the bacteria with the greatest consistency coefficient(Kappa 0.796)and the consistency of Acinetobacter baumannii(Ab),Pseudomonas aeruginosa(Pae),Klebsiella pneumoniae(Kpn),Staphylococcus aureus(Sau),Methicillin-resistant staphylococcus(MRS)and Stenotrophomonas maltophilia(Sm)(Kappa>0.4)while Haemophilus influenzae(Hi)were inconsistent(Kappa=0.174).Conclusion The LAMP is able to identify pathogens quickly and accurately,which helps in the early identification of patients with COPD combined with CAP,and has a certain significance in guiding the diagnosis and treatment of patients.