基于mNGS抗感染策略在重症肺炎中诊治效果的临床研究

Clinical Study about Anti-infection Strategy Based on Metagenomic Next Generation Sequencing in Severe Pneumonia

目的:探讨宏基因组二代测序技术(mNGS)在重症肺炎中病原微生物检测和临床应用价值。方法:将广东省中山市人民医院重症医学科2021年3月到2023年9月收治的64例重症肺炎患者依据是否行mNGS检测随机分为实验组和对照组各32例,两组患者均行肺泡灌洗术;实验组肺泡灌洗液送mNGS和一般细菌培养及真菌培养,对照组送本院检验科行一般细菌培养及真菌培养,两组根据病原微生物检测结果评估行目标抗感染治疗;比较两组病原微生物检测阳性率、平均时长、机械通气时间、血管活性药物使用时间、ICU住院天数、ICU住院费用、病死率等指标。结果:实验组病原微生物检测阳性率明显高于对照组,检测时长明显短于对照组,P均<0.05;实验组机械通气时间、血管活性药物使用时间、ICU住院费均明显少于对照组(P均<0.05);实验组病死率低于对照组,但差异无统计学意义(P>0.05)。结论:mNGS可提高重症肺炎患者病原微生物检测阳性率、缩短检测时长,基于mNGS的抗感染策略可提高治疗效果,促进重症肺炎的精准治疗。

Objective:To investigate the clinical value of metagenomic next-generation sequencing(mNGS)of bronchoalveolar lavage fluid(BALF)in the diagnosis and treatment of severe pneumonia.Methods:Sixty-four patients with severe pneumonia treated in the intensive care unit of Zhongshan People′s Hospital from Mar 2021 to Sep 2023 were randomly divided into experimental group and control group,each group was 32 cases.All patients underwent alveolar lavage.The lavage solution of the control group underwent general bacterial and fungal culture,and the lavage solution of the experimental group underwent mNGS detection and general bacterial and fungal culture.And the anti-infection strategies were adjusted according to the pathogen test results in both groups.The pathogen physical examination rate and the time use,mechanical ventilation time,duration of vasoactive drugs use,ICU hospitalization days,ICU hospitalization expenses and mortality were compared between the two groups.Results:The positive rate of pathogen detection in the experimental group was significantly higher than that in the control group(P<0.05),while the time use of detection in experimental group was shorter;the mechanical ventilation time,duration of vasoactive drugs use,average ICU hospitalization expenses in the experimental group were significantly lower than those in the control group(all P<0.05).The mortality of the experimental group was lower than that in the control,but there was no significant difference in the two groups(P>0.05).Conclusions:Application of mNGS in the severe pneumonia can improve the positive rate of pathogen detection,shorten the detection time,the anti-infection strategy based on mNGS can improve the treatment effect,promote the precise treatment in severe pneumonia.