支气管肺泡灌洗液病原体宏基因组二代测序在下呼吸道感染诊断中的应用价值

Application Value of Metagenomic Next-generation Sequencing of Pathogens in Bronchoalveolar Lavage Fluid for the Diagnosis of Lower Respiratory Tract Infection

目的 探究支气管肺泡灌洗液(BALF)病原体宏基因组二代测序(mNGS)在下呼吸道感染诊断中的应用价值,以提高下呼吸道感染病原体检测正确率、避免延误治疗。方法 选取2019年1月至2021年12月收治的115例下呼吸道感染患者,采集BALF行mNGS、传统方法培养。对比分析mNGS与传统方法病原体检出时间、检出病原体分布情况,分析mNGS与传统方法检测结果的一致性,比较mNGS检出阳性与阴性患者临床资料,并行多因素Logistic回归分析mNGS检测结果影响因素。结果 mNGS病原体检出时间明显短于传统方法(P<0.05);mNGS病原体阳性检出率为74.78%高于传统方法检测的36.52%(P<0.01),mNGS细菌菌株阳性检出率高于传统方法(P<0.05,P<0.01);mNGS与传统方法检测结果的一致性Kappa指数为0.295;mNGS检出阳性与阴性患者在抗生素使用、糖皮质激素或免疫抑制剂使用、白细胞计数及C反应蛋白方面比较差异有统计学意义(P<0.05,P<0.01);多因素Logistic回归分析显示:抗生素使用、糖皮质激素或免疫抑制剂使用、白细胞计数及C反应蛋白与mNGS检测结果无影响(P>0.05)。结论 mNGS能有效提高下呼吸道感染病原体检测正确率,为抗生素精准治疗提供依据,避免延误治疗。

Objective To explore the application value of metagenomic next-generation sequencing(mNGS)of pathogens in bronchoalveolar lavage fluid(BALF)for the diagnosis of lower respiratory tract infection(LRTIs),in order to improve the accuracy of pathogen detection of LRTIs and avoid delayed treatment.Methods A total of 115 patients with LRTIs admitted from January 2019 to December 2021 were selected,and BALF was collected,all of which were cultured by mNGS and traditional methods.The time of pathogen detection and the distribution of detected pathogens were compared and analyzed between mNGS and traditional methods,and the consistency of detection results between mNGS and traditional methods was analyzed.The clinical data of mNGS-positive and negative patients were compared,and multivariate logistic regression was performed to analyze the factors affecting the results of mNGS testing.Results The detection time of pathogens by mNGS was significantly shorter than that by traditional methods(P<0.05).The positive rate of pathogen detection by mNGS was 74.78%,which was higher than that by traditional methods(36.52%)(P<0.01),and the positive detection rate of bacterial strains by mNGS was higher than that by traditional methods(P<0.05,P<0.01).The Kappa index of consistency between mNGS detection and traditional detection method was 0.295,and there were significant differences in antibiotic use,glucocorticoid or immunosuppressant use,white blood cell(WBC)count,and C reactive protein(CRP)between mNGS-positive and negative patients(P<0.05,P<0.01).Multivariate logistic regression analysis showed that antibiotics use,glucocorticoid or immunosuppressant use,WBC,and CRP had no effect on the results of mNGS detection(P>0.05).Conclusion mNGS can significantly improve the accuracy of pathogen detection in LRTIs,provide a basis for precise antibiotic treatment,and avoid delayed treatment.