支气管肺泡灌洗液培养和mNGS检测对社区获得性肺炎/医院获得性肺炎的诊断价值

Value of Bronchoalveolar Lavage Fluid Culture and mNGS Detection in the Diagnosis of CAP/HAP

目的探究支气管肺泡灌洗液(BALF)培养、宏基因组学二代测序(mNGS)检测在社区获得性肺炎(CAP)/医院获得性肺炎(HAP)中的诊断价值及意义。方法选取2022年10月至2024年4月收治的81例CAP/HAP患者,收集BALF,均行微生物培养、mNGS检测,统计BALF微生物培养、mNGS病原体检测结果,比较BALF微生物培养、mNGS检测对不同病原体的检出率,比较BALF微生物培养、mNGS检测对CAP/HAP类型的检出率。结果mNGS检测阳性检出率[86.42%(70/81)]高于BALF微生物培养[22.22%(18/81)],差异有统计学意义(P<0.05);BALF微生物培养阳性18例检出病原体26株,mNGS检测阳性70例检出病原体148株。BALF微生物培养、mNGS对不同病原体的检出率比较差异无统计学意义(P>0.05);mNGS检测对单一型、混合型CAP/HAP的检出率均高于BALF微生物培养,差异有统计学意义(P<0.05);70例mNGS检测阳性样本序列数为(1293.51±394.86)bp,高丰度占比84.29%(59/70),中丰度占比14.29%(10/70),低丰度占比1.43%(1/70)。mNGS检测病原体结果可信度较高。70例mNGS检测阳性CAP/HAP患者检出148株病原体,主要为细菌感染56.76%(84/148),其中以革兰阴性菌为主。结论mNGS检测诊断CAP/HAP的价值明显优于BALF微生物培养,能提高不同病原体种类、不同CAP/HAP类型的检出率,从而指导临床针对性进行抗微生物治疗。

Objective To explore the diagnostic value and significance of bronchoalveolar lavage fluid(BALF)culture and metagenomic next-generation sequencing(mNGS)detection in community-acquired pneumonia(CAP)/hospital-acquired pneumonia(HAP).Methods Eighty-one patients with CAP/HAP treated from October 2022 to April 2024 were selected.BALF was collected,and microbial culture and mNGS detection were performed.BALF microbial culture and mNGS pathogen detection results were recorded.The detection rates of BALF microbial culture and mNGS detection for different pathogens were compared,and the detection rates of BALF microbial culture and mNGS detection for CAP/HAP type were compared.Results The positive detection rate of mNGS[86.42%(70/81)]was higher than that of BALF microbial culture[22.22%(18/81)],showing significant difference(P<0.05).Of 18 patients with positive BALF microbial culture,26 strains of pathogens were detected,and of 70 patients with positive mNGS detection,148 strains of pathogens were detected.There was no significant difference in the detection rate of different pathogens between BALF microbial culture and mNGS detection(P>0.05).The detection rate of mNGS for both single and mixed CAP/HAP was higher than that of BALF microbial culture,with a statistically significant difference(P<0.05).The sequence number of 70 positive samples detected by mNGS was(1293.51±394.86)bp,with a high abundance of 84.29%(59/70),a medium abundance of 14.29%(10/70),and a low abundance of 1.43%(1/70).The reliability of the results from mNGS in detecting pathogens was high.In 70 patients with positive mNGS detection of CAP/HAP,148 strains of pathogens were detected,mainly bacterial infections(56.76%,84/148),with Gram-negative bacteria being the predominant type(39.86%).Conclusion The value of mNGS detection in diagnosing CAP/HAP is significantly better than that of BALF microbial culture.It can improve the detection rate of different pathogen species and different types of CAP/HAP,thereby guiding targeted antimicrobial treatment in clinical practice.