基于呼吸道标本靶向宏基因组测序技术的社区获得性肺炎患儿病原学检测结果分析

Analysis of Etiological Testing Results of Children with Community-Acquired Pneumonia Based on Targeted Metagenomic Next-Generation Sequencing Technology of Respiratory Specimens

目的:分析基于呼吸道标本靶向宏基因组测序技术(tNGS)的社区获得性肺炎患儿病原学检测结果。方法:选取2023年6—7月南方医科大学第三附属医院收治的社区获得性肺炎患儿115例作为研究对象,留取痰液、肺泡灌洗液或咽拭子标本行tNGS分析,记录标本情况、病原体检出情况,并比较不同年龄患儿病原体检出情况。结果:115例患儿共检测tNGS标本123份,其中8例患儿送检肺泡灌洗液和痰液2种标本,单独痰液标本83份,单独肺泡灌洗液标本5份,咽拭子19份。123份标本中,病原体总检出率为98.37%(121/123),共检出病原体205株,其中以肺炎支原体最多,占比40.00%(82/205)。单一病原体感染检出58份,检出率为47.15%(58/123),其中以肺炎支原体多见,占比75.86%(44/58)。混合病原体感染检出63份,检出率为51.22%(63/123),其中以2种病原体混合感染多见,占比76.19%(48/63)。不同年龄段患儿肺炎链球菌、人呼吸道合胞病毒、博卡病毒、副流感病毒、肺炎支原体检出率比较,差异有统计学意义(P<0.05)。其中肺炎链球菌以1~<3岁检出率较高,人呼吸道合胞病毒以<1岁、1~<3岁检出率较高,博卡病毒、副流感病毒以1~<3岁检出率较高,肺炎支原体检出率随年龄增长呈上升趋势。结论:社区获得性肺炎患儿tNGS病原体检出率较高,其中混合感染占比较高,不同年龄段患儿原体感染有所差异,需根据儿童感染特点积极开展早期病原学检测,为临床诊疗提高依据。

Objective:To analyze the etiological testing results of children with community-acquired pneumonia based on targeted metagenomic next-generation sequencing(tNGS)technology of respiratory specimens.Methods:A total of 115 children with community-acquired pneumonia admitted to Southern Medical University Third Hospital from June 2023 to July 2023 were selected as the study subjects.Sputum,alveolar lavage fluid or throat swab specimens were collected for tNGS analysis.The specimen condition and pathogen detection were recorded.The pathogen detection of children at different ages was compared.Results:A total of 123 tNGS specimens were tested in 115 children.Among them,8 children had alveolar lavage fluid and sputum specimens submitted for testing.There were 83 sputum specimens alone,5 alveolar lavage fluid specimens alone,and 19 throat swabs.Among the 123 specimens,the total detection rate of pathogens was 98.37%(121/123),and a total of 205 strains of pathogens were detected,with Mycoplasma pneumoniae being the most prevalent,accounting for 40.00%(82/205).Single pathogen infection was detected in 58 specimens,and the detection rate was 47.15%(58/123),with Mycoplasma pneumoniae being the most prevalent,accounting for 75.86%(44/58).Mixed pathogen infection was detected in 63 specimens,and the detection rate was 51.22%(63/123),with mixed infection of two pathogens being the most prevalent,accounting for 76.19%(48/63).There were statistically significant differences in the detection rates of Streptococcus pneumoniae,human respiratory syncytial virus,bocavirus,parainfluenza virus,and Mycoplasma pneumoniae in children at different ages(P<0.05).Among them,the detection rate of Streptococcus pneumoniae was higher at the age of 1 to<3 years,the detection rate of human respiratory syncytial virus was higher at the age of<1 year and 1 to<3 years,the detection rate of bocavirus and parainfluenza virus was higher at the age of 1 to<3 years,and the detection rate of Mycoplasma pneumoniae increased with age.Conclusion:The detection rate of pathogens in children with community-acquired pneumonia by tNGS is relatively high,and the proportion of mixed infection is relatively high,and the infection of pathogens in children at different ages by tNGS is different.It is necessary to actively carry out early etiological detection according to the infection characteristics of children,so as to improve the basis for clinical diagnosis and treatment.