Bronchoalveolar lavage fluid assessment facilitates precision medicine for lung cancer

Lung cancer is the most common and fatal malignant disease worldwide and has the highest mortality rate among tumor-related causes of death.Early diagnosis and precision medicine can significantly improve the survival rate and prognosis of lung cancer patients.At present,the clinical diagnosis of lung cancer is challenging due to a lack of effective non-invasive detection methods and biomarkers,and treatment is primarily hindered by drug resistance and high tumor heterogeneity.Liquid biopsy is a method for detecting circulating biomarkers in the blood and other body fluids containing genetic information from primary tumor tissues.Bronchoalveolar lavage fluid(BALF)is a potential liquid biopsy medium that is rich in a variety of bioactive substances and cell components.BALF contains information on the key characteristics of tumors,including the tumor subtype,gene mutation type,and tumor environment,thus BALF may be used as a diagnostic supplement to lung biopsy.In this review,the current research on BALF in the diagnosis,treatment,and prognosis of lung cancer is summarized.The advantages and disadvantages of different components of BALF,including cells,cell-free DNA,extracellular vesicles,and micro RNA are introduced.In particular,the great potential of extracellular vesicles in precision diagnosis and detection of drug-resistant for lung cancer is highlighted.In addition,the performance of liquid biopsies with different body fluid sources in lung cancer detection are compared to facilitate more selective studies involving BALF,thereby promoting the application of BALF for precision medicine in lung cancer patients in the future.

Bronchoalveolar lavage fluid metagenomic next-generation sequencing assay for identifying pathogens in lung cancer patients

Background:For patients with lung cancer,timely identification of new lung lesions as infectious or non-infectious,and accurate identification of pathogens is very important in improving OS of patients.As a new auxiliary examination,metagenomic next-generation sequencing(mNGS)is believed to be more accurate in diagnosing infectious diseases in patients without underlying diseases,compared with conventional microbial tests(CMTs).We designed this study tofind out whether mNGS has better performance in distinguishing infectious and non-infectious diseases in lung cancer patients using bronchoalveolar lavagefluid(BALF).Materials and Methods:This study was a real-world retrospective review based on electronic medical records of lung cancer patients with bronchoalveolar lavage(BAL)and BALF commercial mNGS testing as part of clinical care from 1 April 2019 through 30 April 2022 at The First Affiliated Hospital of Sun Yat-sen University.164 patients were included in this study.Patients were categorized into the pulmonary non-infectious disease(PNID)group(n=64)and the pulmonary infectious disease(PID)group(n=100)groups based onfinal diagnoses.Results:BALF mNGS increased the sensitivity rate by 60%compared to CMTs(81%vs.21%,p<0.05),whereas there was no significant difference in specificity(75%vs.98.4%,p>0.1).Among the patients with PID,bacteria were the most common cause of infection.Fungal infections occurred in 32%of patients,and Pneumocystis Yersini was most common.Patients with Tyrosine kinase inhibitors(TKIs)therapy possess longer overall survival(OS)than other anti-cancer agents,the difference between TKIs and immuno-checkpoint inhibitors(ICIs)was insignificant(median OS TKIs vs.ICIs vs.Anti-angiogenic vs.Chemo vs.Radiotherapy=76 vs.84 vs.61 vs.58 vs.60).Conclusions:our study indicates that BALF mNGS can add value by improving overall sensitivity in lung cancer patients with potential pulmonary infection,and was outstanding in identifying Pneumocystis infection.It could be able to help physicians adjust the follow-up treatment to avoid the abuse of antibiotics.

Value of eosinophil count in bronchoalveolar lavage fluid for diagnosis of allergic bronchopulmonary aspergillosis: A case report

BACKGROUND An immediate hypersensitive immune response to Aspergillus fumigatus antigens is one of the main characteristic features of allergic bronchopulmonary aspergillosis(ABPA).As ABPA is an allergic respiratory disease,immunoglobulin E and peripheral-blood eosinophilia have been used as diagnostic indicators.However,eosinophilia in bronchoalveolar lavage fluid(BALF)has not been considered in the diagnostic criteria for ABPA.CASE SUMMARY We present a case of ABPA in which the eosinophil count in peripheral blood was not increased,whereas the eosinophil percentage in BALF reached 60%.After antifungal and hormone therapy,imaging revealed very good resolution of lung infiltration.CONCLUSION The value of the eosinophil count in BALF for the diagnosis of ABPA is worthy of the clinician's attention,especially when the patient’s clinical features lack specificity and the diagnostic parameters are negative.

Improving effect of sputum aspiration combined with bronchoalveolar lavage by fiber bronchoscope on the condition and inflammation in lung cancer patients with postoperative pulmonary infection

Objective:To study the improving effect of sputum aspiration combined with bronchoalveolar lavage by fiber bronchoscope on the condition and inflammation in lung cancer patients with postoperative pulmonary infection.Methods:A total of 78 patients with lung cancer who received surgical treatment in our hospital between August 2013 and January 2015 and were with postoperative infection were selected as the research subjects and randomly divided into two groups, control group received mechanical ventilation therapy, observation group received bronchoalveolar lavage by bronchoscope combined with mechanical ventilation, and the inflammatory factor levels, RAAS system activity and respiratory mechanics indexes of two groups were determined after treatment.Results:3 d after treatment, serum hs-CRP, TNF-α, IL-8, PCT, renin, angiotensin II and aldosterone levels of observation group were lower than those of control group, and PIP, Raw and WOB values were lower than those of control group while Cdyn value was higher than that of control group.Conclusion:For lung cancer patients with postoperative pulmonary infection, bronchoalveolar lavage by bronchoscope combined with mechanical ventilation can optimize patients' condition, relieve systemic inflammatory response and improve respiratory function, and it has positive clinical significance.

Effect of fiberoptic bronchoscopic bronchoalveolar lavage with ambroxol on the SIRS and target organ damage in patients with severe pneumonia complicated by respiratory failure

Objective:To study the effect of fiberoptic bronchoscopic bronchoalveolar lavage with ambroxol on the systemic inflammatory response syndrome (SIRS) and target organ damage in patients with severe pneumonia complicated by respiratory failure.Methods: A total of 68 patients with severe pneumonia complicated by respiratory failure who received inpatient treatment in our hospital between July 2013 and December 2016 were collected and then divided into the control group (n=35) who received conventional therapy and the observation group (n=33) who received fiberoptic bronchoscopic bronchoalveolar lavage with ambroxol + conventional therapy after the therapies were reviewed. The systemic inflammatory response as well as cardiac and liver function before and after treatment were compared between two groups of patients.Results: Before treatment, differences in serum levels of inflammatory factors, myocardial enzyme spectrum and liver function indexes were not statistically significant between the two groups of patients. After treatment, serum inflammatory factors IL-6, IL-8, TNF-α and CRP levels in observation group were lower than those in control group;serum myocardial enzyme spectrum LDH,α-HBDH, CKMB and cTnI levels were lower than those in control group;serum liver function index Alb content was higher than that in control group while ALP, TBA, ALT and AST contents were lower than those in control group.Conclusion:Fiberoptic bronchoscopic bronchoalveolar lavage with ambroxol can effectively reduce the degree of SIRS, and also reduce the cardiac and liver function injury in patients with severe pneumonia complicated by respiratory failure.

HPLC Quantification of Dexamethasone Palmitate in Bronchoalveolar Lavage Fluid of Rat after Lung Delivery with Large Porous Particles

A high-performance liquid chromatography (HPLC) method has been developed and validated for the determination of dexamethasone palmitate (DXP) in bronchoalveolar fluid lavage samples (BALF). DXP in rat BALFs containing the internal standard (IS), testosterone decanoate (TD), was extracted using a mixture of chloroform and methanol (9:1, v/v). Extracts were then centrifuged, dried and dissolved in acetonitrile. A chromatographic separation based on an isocratic elution was done using acetonitrile and water (85:15, v/v) as a mobile phase at a flow rate of 1.2 mL/min. The graph of the developed method was linear within the tested calibration range of 0.5 - 40 μg/mL. The overall extraction recovery of DXP from BALF samples was 84.3% ± 1.6%. The accuracy (relative error) and precision (coefficient of variation) values were within the pre-defined limits of ≤15% at all concentrations. This methodology has been applied to determine levels of DXP in BALF samples collected from rats treated with DXP large porous particles. The measured concentrations were successfully evaluated using a non-compartment pharmacokinetic model. Since the developed method requires only a microvolume (100 μL) of BALF sample for analysis, it is therefore particularly suitable for the evaluation of drug biodistribution in lung.

Effects of early bronchoalveolar lavage fluid collected from dogs with smoke inhalation injury on the lungs of rats

Objective: Whether early massive bronchoalveolar lavage can remove the harmful substances from the lungs injured with smoke inhalation remains uncertain. This study was designed to observe the effects of early massive bronchoalveolar lavage fluid (BALF) on the healthy lungs in rats. Methods: Mongrel dogs were inflicted with severe smoke inhalation injury. The injured lungs were lavaged with large amount of normal saline in the first hour after injury and the BALF was collected. The BALF was injected into the healthy lungs of 30 rats (group C) in the dosage of 5 ml/kg. The functions and pathological changes of the lungs were observed 24 h after perfusion with the BALF. The data were compared with those of 23 rats (group B) whose lungs were perfused with the BALF collected from normal dogs and those of 21 rats (group A) whose lungs were perfused with normal saline. Results: The mortality rate 24 h after lung perfusion was higher in group C than in groups A and B. The survivors of group C exhibited fluctuation of respiratory rate (RR), remarkable decrease of PaO 2, significantly higher content of lung water, decrease of total static pulmonary compliance and pulmonary expansion index, and increasse of inflammatory cytokines in the tissues of lungs. Only slight mechanic obstructive effect on the airway was observed in rats of group A and B. The pathological changes of the lungs of the rats in group C were similar to those of the dogs with actual smoke inhalation injury. Conclusion: Our findings indicate that the BALF collected from dogs with acute severe smoke inhalation injury in the early stage after injury injured the normal lungs of rats with the bioactive substances in the BALF. These findings show us that it is a valuable therapeutic procedure to apply massive bronchoalveolar fluid lavage in the early stage after inhalation injury.

Comparison on Detection Results of Pathogen Nucleic Acids for Bronchoalveolar Lavage Fluid of Lung Infection Infants Between Uighur Nationality and Han Nationality

Objective:To analyze the detection results of pathogen nucleic acids for bronchoalveolar lavage fluid(BALF)of lung infection infants from Uighur nationality and Han nationality.Methods:A retrospective analysis was performed on the 318 infants with lung infection who were admitted to the hospital from April 2018 to April 2019.According to their nationality,they were divided into Uighur nationality group(190 cases)and Han nationality group(128 cases).The BALF specimens were collected to test pathogen nucleic acid.The distribution and positive rates of[respiratory syncytial virus(RSV),adenovirus(ADV),influenza virus A(IFA),influenza virus B(IFB),parainfluenza virus type 1(PIV I),parainfluenza virus type 2(PIV II),parainfluenza virus type 3(PIV III)],bacteria(Streptococcus pneumoniae,Haemophilus influenzae,staphylococcus aureus,Pseudomonas aeruginosa,klebsiella pneumoniae),Mycoplasma pneumoniae(MP)and Chlamydia pneumoniae(CP)in both groups were observed and compared.Results:The virus detection for RSV,ADV and PIV III were on the top three in BALF from the children in both groups.The total positive rate of virus examination in Uighur nationality group was higher than that in Han nationality group(P<0.05).BALF in both groups was mainly on Streptococcus pneumoniae.The total positive rate of bacteria,MP and detection rate of chlamydia were higher in Uighur nationality group were higher than those in Han nationality group(P<0.05).Conclusion:The pathogen nucleic acid examination for bronchoalveolar lavage fluid in infants with lung viral infection is in the majority,mainly on RSV virus infection.The positive rates of virus,bacteria,MP and CP of children in Uighur nationality are high than those in Han nationality.

Expression of endostatin in serum and bronchoalveolar lavage fluid in patients with lung cancer

Objective To evaluate the expression of endostatin in bronchoalveolar lavage fluid (BALF) and serum in patients with lung cancer,and to analysis the relationship between endostatin expression and clinical prognosis as well as pathophysiological characteristics. Methods The samples of serum and BALF were obtained from 57

XpertMTB/RIF Assay for the Diagnosis of Pulmonary Tuberculosis Based on Bronchoalveolar Lavage Fluid:A Systematic Review and Meta-analysis

Currently,tuberculosis(TB)is the second most lethal disease in the world caused by a single infectious pathogen.Rapid diagnosis of TB is of great importance for its treatment and management.Xpert MTB/RIF is a novel rapid diagnostic assay for the diagnosis of pulmonary TB(PTB).Use of the Xpert assay based on bronchoalveolar lavage fluid(BALF)samples is indicated when TB is suspected and sputum smears or cultures are negative.The aim of this meta-analysis was to systematically evaluate the diagnostic performance of the Xpert assay based on BALF samples for the diagnosis of PTB.A systematic review of previously published articles was performed,and rel-evant data were extracted.Meta-DiSc 1.4 and Stata 12.0 were used to analyze the data.When Mycobacterium tuberculosis cultures were used as the criterion standard,the combined sensitivity of BALF-based Xpert was 0.89(95%CI,0.87–0.91),the specificity was 0.87(95%CI,0.85-0.88),the positive likelihood ratio was 8.28(95%CI,5.39–12.71),the negative likelihood ratio was 0.14(95%CI,0.10–0.19)and the diagnostic ratio was 84.08(95%CI,42.00–168.31).When composite reference standard was used as the criterion standard,the above observations were 0.69(95%CI,0.67–0.72),0.98(95%CI,0.97–0.98),41.40(95%CI,14.56–117.71),0.28(95%CI,0.21–0.37)and 190.47(95%CI,50.56–717.54),respectively.The area under the summary receiver operating characteristic curve was close to 1 for both.Overall,the Xpert MTB/RIF assay based on BALF samples showed high sensitivity and specificity for the diag-nosis of PTB and seems to be a reliable rapid detection method.

支气管肺泡灌洗联合俯卧位治疗儿童肺炎支原体肺炎伴肺不张疗效的前瞻性随机对照研究

目的探讨支气管肺泡灌洗(bronchoalveolar lavage,BAL)联合俯卧位在儿童肺炎支原体肺炎(Mycoplasma pneumoniae pneumonia,MPP)伴肺不张中的疗效及对肺功能的影响。方法前瞻性选取2020年11月—2023年5月在内蒙古鄂尔多斯市中心医院住院治疗的94例MPP伴肺不张的患儿为研究对象,随机分为治疗组和对照组,每组各47例。治疗组在常规治疗及BAL基础上加以俯卧位治疗,对照组给予常规治疗及BAL。比较两组患儿发热、肺部体征、住院时间、肺复张和肺功能改善情况。结果治疗组肺部体征改善时间、住院时间短于对照组,住院第7天、出院当天及出院后1周肺复张有效率高于对照组(P<0.05)。治疗组出院当天及出院后1周用力肺活量占预测值百分比、第1秒用力呼气量占预测值百分比、第1秒用力呼气量/用力肺活量、用力呼出50%肺活量的呼气流量占预测值百分比、用力呼出75%肺活量的呼气流量占预测值百分比及最大呼气中期流量占预测值百分比均高于对照组(P<0.05)。两组患儿体温降至正常时间比较差异无统计学意义(P>0.05)。结论BAL联合俯卧位在儿童MPP伴肺不张治疗中,有利于缩短肺部体征改善时间及住院时间,有利于肺复张和肺功能的改善。

儿童重症肺炎支气管肺泡灌洗液的病原菌及药敏试验分析

目的了解儿童重症肺炎支气管肺泡灌洗液(BALF)的病原菌及药敏试验情况。方法选取该院2021年1月至2023年4月收治的100例重症肺炎患儿作为研究对象,对所有患儿进行支气管镜肺泡灌洗,并分析其BALF病原菌及药敏试验情况。结果100例患儿BALF中共培养出病原菌131株,革兰阴性菌98株(74.81%),革兰阳性球菌33株(25.19%),其中流感嗜血杆菌(25.19%)、肺炎链球菌(21.37%)占比较高,卡他布兰汉菌(15.27%)、肺炎克雷伯菌(11.45%)其次。重症肺炎患儿BALF中前4位病原菌主要以<1岁(97.37%)、1~3岁(96.88%)占比较高,>3~7岁(94.12%)、>7~14岁(92.31%)相对较少。各年龄BALF中流感嗜血杆菌、卡他布兰汉菌、肺炎克雷伯菌分布情况比较,差异均无统计学意义(P>0.05);各年龄BALF中肺炎链球菌分布情况比较,差异有统计学意义(P<0.05)。20株流感嗜血杆菌对四环素、阿莫西林-克拉维酸、头孢噻肟、复方磺胺甲噁唑均较敏感,对氯霉素敏感性其次,对氨苄西林、头孢克洛、头孢呋辛耐药性均较高;15株卡他布兰汉菌对头孢噻肟较敏感,对氨苄西林耐药性最高;8株肺炎克雷伯菌对头孢噻肟较敏感,对氨苄西林、头孢呋辛、氯霉素耐药性均较高,对阿莫西林-克拉维酸、四环素耐药性其次;20株肺炎链球菌对万古霉素、氯霉素均较敏感,对青霉素G、泰利霉素敏感性其次,对复方磺胺甲噁唑耐药性较高,对四环素、头孢噻肟、克林霉素耐药性其次。结论儿童重症肺炎BALF中病原菌以流感嗜血杆菌、肺炎链球菌多见,且0~3岁患儿病原菌占比高于>3~14岁,临床应合理用药以预防耐药菌株产生。

床旁纤维支气管镜肺泡灌洗注入抗生素在老年重症肺炎患者中的应用价值

目的探索纤维支气管镜肺泡灌洗注入抗生素在老年重症肺炎患者中的应用价值。方法回顾性分析2021年8月至2022年12月我院收治的126例老年重症肺炎患者的临床资料,根据治疗方式分为试验组(n=57)和对照组(n=69)。两组患者均接受纤维支气管镜肺泡灌洗,试验组患者于灌洗结束后,将敏感抗生素注入病变位置。比较两组患者患者治疗前后白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、降钙素原(PCT)、氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、机械通气时间、ICU住院时间、临床疗效。结果试验组总有效率显著高于对照组(P<0.05)。治疗后,试验组的IL-6、TNF-α、CRP、PCT水平显著低于对照组,PaCO_(2)水平显著低于对照组(P<0.05),机械通气时间与ICU住院时间明显短于对照组,差异均有统计学意义(P<0.05)。结论肺泡灌洗后注入抗生素可降低老年重症肺炎患者血清炎症因子水平、优化血气指标、缩短机械通气时间、ICU住院时间、提高整体疗效。

Analysis of the T cell receptor Vδ region gene repertoire in bronchoalveolar lavage fluid (BALF) and peripheral blood of asthmatics

Objective To explore the role of γδT cells in the airway of asthmatics and to identify the forces which induce and maintain the inflammatory processMethods Peripheral blood (PB) and bronchoalveolar lavage fluid (BALF) were obtained from7 asthmatic subjects and 7 nonsmoker control subjects The percentage of γδT cells in the PB and BALF was measured by immunofluorescent staining and flow cytometry The frequency of usage and the clonality of Vδ subfamilies (Vδ 1-Vδ 3) were assessed by RTPCR and gene scanning Results A higher proportion of γδT cell was detected in the BALF of asthmatic subjects (7.8%±4.7%) than that from control subjects (3.3%±3.0%, P=0.04) No selective usage for a particular Vδ subfamily was found, but the relative expression level of Vδ 1 was significantly higher in the asthmatic airway (44%±13%) than in the control (19%±5%, P=0.0002) In asthmatic subjects, the monoclonal or oligoclonal expansion of γδT lymphocytes was predominant in the BALF, especially Vδ 1+ T lymphocytes Conclusions Antigenic specific γδT cells might play an important role in the inducement and maintenance of airway inflammation Persistent antigenic stimulation may be the key factor that maintains chronic airway inflammation in asthma

2017—2022年山东地区肺泡灌洗液分离菌的构成及药物敏感性分析

目的了解山东地区成人和儿童肺泡灌洗液的分离菌株的构成及耐药性。方法回顾分析2017年1月—2022年12月山东省儿童细菌耐药监测研究协作网(SPARSS)59家网点单位支气管肺泡灌洗液(BALF)中分离菌株的分布及药物敏感性。结果共收集BALF中分离菌12992株,前五位细菌分别为铜绿假单胞菌(16.51%)、肺炎克雷伯菌(14.66%)、鲍曼不动杆菌(13.97%)、金黄色葡萄球菌(9.21%)、嗜麦芽窄食单胞菌(6.27%);儿童分离菌占21.44%,主要为金黄色葡萄球菌(19.74%)、肺炎链球菌(17.73%)和流感嗜血杆菌(13.60%);成人分离菌占78.56%,主要为铜绿假单胞菌(19.01%)、肺炎克雷伯菌(16.59%)和鲍曼不动杆菌(16.35%)。BALF分离革兰阴性菌占75.0%,成人分离的肺炎克雷伯菌、大肠埃希菌对头孢曲松/头孢噻肟的耐药率分别为36.6%/31.0%和67.1%/61.0%,儿童株为57.5%/62.1%和71.1%/68.1%。成人分离肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌对碳青霉烯类药物的耐药率分别为7.7%~8.3%、2.4%~3.3%、16.5%~19.2%和85.2%~85.3%,儿童分离株为15.4%~16.2%、3.2%~4.9%、11.9%~13.8%和34.7%~45.0%,成人CRKP和CRBA的检出率自2017年的1.2%和70.6%升至2022年的12.5%和84.4%。儿童和成人分离的流感嗜血杆菌对氨苄西林的耐药率分别为83.3%和78.7%,BLNAR株的检出率分别为9.3%和12.0%。革兰阳性菌占17.7%,以金黄色葡萄球菌和肺炎链球菌为主,成人与儿童的耐甲氧西林金黄色葡萄球菌检出率分别为22.58%和29.73%,分别从2017年的42.3%和36.8%降至2022年的19.6%和26.6%,成人与儿童青霉素敏感的肺炎链球菌检出率分别为97.4%和94.6%,未发现对万古霉素或利奈唑胺耐药的金黄色葡萄球菌和肺炎链球菌。结论2017—2022年山东地区成人与儿童BALF分离菌株的构成和药物敏感性存在较大差异,应加强当地流行病学及耐药性的监测,把握不同人群病原谱和耐药性的特点及变化趋势,以便合理经验用药;加强抗菌药物管理以遏制耐药菌的传播,减轻患者治疗负担。

Interleukin-6 in bronchoalveolar lavage fluid from patients with COPD

Objective To obtain new insights into the behavior of Interleukin-6(IL-6)in bronchoalveolar lavage fluid (BALF)and released from alveolar macrophages(AM)in chronic obstructive pulmonary diseases (COPD),and reveal the relationship between IL-6 and the development of emphysema in COPD.Methods IL-6 in BALF and released by AM in BALF were examined in 7 non-smoking subjects and 21 patients with COPD.According to the 95% confidence limits of IL-6 in BALF from non-smoking subjects,the patients were divided into two groups:those who were within the limits were assigned to the first group,and those who were above the limits were assigned to the second group.Results The concentration of IL-6 released by AM was much higher in the second group than in the first one.Between the two groups,significant differences were found in pulmonary function.Conclusion Our results suggest that the concentration of IL-6 released by AM may be related with pulmonary function,and IL-6 may play a role in the development of emphysema in patients with COPD.

BAL联合M-ROSE在潜在供肺维护中的作用

目的探讨BAL联合M-ROSE在潜在供肺维护中的作用。方法选取昆明医科大学附属甘美医院重症医学科2020年09月至2022年12月收治的符合纳入标准的脑死亡患者行BAL,留取灌洗液行M-ROSE比较病原菌检出率及初步诊断时间。根据M-ROSE结果阳性的患者采用经验性抗感染治疗,评估抗感染治疗48 h前后的氧合指数、胸部X线评分、感染指标(WBC、CRP、PCT)变化。结果(1)病原菌检出率比较:MROSE对细菌感染初步诊断结果与检验科报告的结果表现出高度一致性(Kappa=0.921,P<0.001);(2)诊断时效性比较:M-ROSE初步诊断时间与常规涂片报告时间、微生物培养时间比较,差异有统计学意义(P<0.001);(3)抗感染治疗48 h的疗效比较:抗感染治疗前后氧合指数,白细胞,超敏C反应蛋白差异无统计学意义(P>0.05);抗感染治疗前后胸部X线,降钙素原差异有统计学意义(P<0.05)。结论BAL联合M-ROSE在潜在供肺肺部感染中的诊断时效性高,可以为供肺维护早期抗感染治疗提供初步的依据。

mNGS在老年社区获得性肺炎病原学诊断的临床价值

目的分析宏基因二代测序(metagenomic next-generation sequencing,mNGS)在老年社区获得性肺炎(community acquired pneumonia,CAP)病原学检测的临床价值。方法以收治的112例老年CAP患者为研究对象,比较mNGS与常规微生物学试验(sconventional microbiological tests,CMTs)对病原体的检出效率。采用Fisher精确检验统计及ROC曲线分析其结果,比较mNGS与CMTs的诊断性差异。结果mNGS对老年CAP患者的总诊断率优于CMTs,差异有统计学意义(94.6%vs.65.2%,P<0.001);mNGS的检测时间显著低于CMTs的检测时间[(26.3±5.9)h vs.(85.5±6.4)h;t=21.034,P<0.05]。mNGS在细菌、病毒、真菌、非典型病原体的检测例数均高于CMTs。mNGS对混合感染标本检出率为76.4%,明显高于CMTs的60.3%(X^(2)=6.851,P<0.05)。mNGS与CMTs的病原体检测一致者64例,部分一致者35例,完全不一致者13例。结论mNGS对老年社区获得性肺炎能检测出更多和更广谱的病原体,且具有重要的临床价值。

肺部感染儿童支气管肺泡灌洗液病原及细胞学分析

目的分析肺部感染儿童支气管肺泡灌洗液(BALF)中的病原及细胞学成分,为临床提供诊断及治疗依据方法选取2021年8月至2022年10月于泉州市儿童医院住院治疗的42例患儿作为研究对象,其中23例BALF培养确诊为细菌感染性肺炎的患儿为细菌性肺炎组,19例支气管异物行异物取出术后BALF培养无细菌生长的患儿为支气管异物组。采用液基细胞学沉降法对上述两组患儿BALF进行病理学分析。结果23例细菌性肺炎以肺炎链球菌感染为主,肺部CT易合并肺不张;19例支气管异物以左主支气管异物多见,其中以坚果类异物为主。细菌性肺炎组的中性粒细胞百分比、C反应蛋白(CRP)水平高于支气管异物组,差异有统计学意义(P<0.05);细菌性肺炎组的淋巴细胞百分比低于支气管异物组,差异有统计学意义(P<0.05);细菌性肺炎组BALF中性粒细胞百分比高于支气管异物组,差异有统计学意义(P<0.05);两组BALF中淋巴细胞百分比、巨噬细胞百分比、纤毛柱状上皮细胞百分比比较,差异无统计学意义(P>0.05)。结论儿童细菌性肺炎以肺炎链球菌感染多见,其BALF细胞学组成以中性粒细胞为主,这为临床诊断及治疗提供了依据,避免临床抗生素滥用。

急性下呼吸道感染患儿支气管肺泡灌洗液病原菌特征分析

目的研究急性下呼吸道感染患儿病原菌特点,探讨支气管肺泡灌洗液荧光PCR检测对儿童急性呼吸道感染病原学的诊断价值。方法选择2018年6月至2019年5月吉林大学第一医院收治的急性呼吸道感染住院患儿172例为研究对象,收集其支气管肺泡灌洗液,通过多重实时荧光定量PCR检测其病原体。结果本研究中172例支气管肺泡灌洗液样本致病菌检出有106例,阳性率为61.63%(106/172);排在前三位的病原菌检出率依次为肺炎链球菌26.74%(46/172),流感嗜血杆菌17.44%(30/172),百日咳鲍特菌8.14%(14/172),且不同年龄组的病原菌检出率存在差异,P<0.01。结论急性下呼吸道感染患儿支气管肺泡灌洗液中肺炎链球菌检出率最高,依次为流感嗜血杆菌、百日咳鲍特菌、卡他莫兰汉菌、金黄色葡萄球菌。急性下呼吸道感染患儿的病原菌检出率在不同年龄段分组中存在差异。