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.

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。

血清IL-17联合血清GM试验和BALF-GM试验对ICU侵袭性肺曲霉菌病的诊断价值

目的通过监测ICU内具有真菌侵袭高风险的肺部感染患者血清IL-17水平、血清半乳甘露聚糖(GM)试验及肺泡灌洗液(BALF)-GM试验变化,探索联合检测对于早期诊断ICU侵袭性肺曲霉病(IPA)的价值。方法选择60例肺部感染且具有真菌感染相关危险因素的患者,将其分为2组,试验组为确诊+临床诊断IPA组(30例);对照组为拟诊IPA组(30例)。分别进行年龄、危重度评分、血常规(淋巴细胞绝对值)、血清IL-17水平、血清GM试验、BALF-GM试验、BALF真菌培养鉴定和细胞学检测以及肺部影像学检查,并采集数据。应用电化学发光法检测各组血清IL-17水平,采用酶联免疫吸附试验进行GM试验检测。应用logistic回归分析及绘制受试者工作特征曲线(ROC),分析血清IL-17水平、血清GM试验以及BALF-GM试验诊断IPA的效能;进一步评估3种指标联合检测对早期诊断IPA的效能。两两指标联合为血清GM试验联合BALF-GM试验、血清IL-17联合血清GM试验、血清IL-17联合BALF-GM试验。结果试验组患者血清IL-17、血清GM试验以及BALF-GM试验水平均明显高于对照组(P<0.05);logistic回归分析及ROC曲线分析结果显示,血清IL-17联合BALF-GM试验对IPA诊断的灵敏度为86.7%,特异度为80.0%,曲线下面积为0.852,高于血清IL-17联合血清GM及血清GM联合BALF-GM检测。结论IPA患者血清IL-17高表达,且与BALF-GM试验联合检测,能提升IPA的早期诊断价值。

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.

肺结核患者Th1/Th2细胞状态与BALF中微生物群及Notch2 mRNA、IL-27 mRNA表达的相关性

【目的】探讨肺结核患者Th1/Th2细胞状态与支气管肺泡灌洗液(BALF)中微生物群及Notch2、白细胞介素-27(IL-27)表达的相关性。【方法】776例肺结核患者,按病情进展情况分为活动组(n=370)和非活动组(n=406),另选352例非肺结核呼吸系统疾病患者作为对照组,检测患者BALF中微生物群水平,Notch2 mRNA、IL-27 mRNA表达水平和外周血Th1、Th2细胞比例,分析Th1/Th2与BALF中微生物群、Notch2 mRNA、IL-27 mRNA表达的相关性。【结果】活动组、非活动组外周血Th1、Th2细胞比例及Th1/Th2值均低于对照组,活动组Th1细胞比例及Th1/Th2值低于非活动组(P<0.05),但两组Th2细胞比例比较,差异无统计学意义(P>0.05);活动组、非活动组嗜血杆菌、奈瑟菌数量,IL-27 mRNA表达高于对照组,链球菌数量、Notch2 mRNA表达低于对照组(P<0.05),且活动组嗜血杆菌、奈瑟菌数量,IL-27 mRNA高于非活动组,链球菌数量、Notch2 mRNA表达低于非活动组(P<0.05)。Pearson相关性分析显示,肺结核患者Th1/Th2值与链球菌数量及Notch2 mRNA表达呈正相关(P<0.05),与嗜血杆菌、奈瑟菌数量、IL-27 mRNA表达呈负相关(P<0.05)。【结论】肺结核患者的Th1/Th2细胞比例偏低,且随病情发展进一步降低,该免疫失衡与患者BALF中嗜血杆菌、奈瑟菌、链球菌感染及Notch2 mRNA、IL-27 mRNA表达有关。

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

血清和BALF半乳甘露聚糖检测对非中性粒细胞减少患者侵袭性肺曲霉病的诊断价值

目的 探讨血清和支气管肺泡灌洗液(BALF)半乳甘露聚糖(GM)检测对非中性粒细胞减少患者侵袭性肺曲霉菌病(IPA)的诊断价值。方法 回顾性分析2020年4月至2023年4月诊治的104例患者,其中IPA组37例,非IPA组67例,检测比较患者BALF和血清GM水平,分析BALF和血清GM检测的相关性,受试者工作特征(ROC)曲线确定BALF GM检测的临界值,并比较两种检测的诊断效能。结果 IPA组BALF和血清GM值高于非IPA组,不同基础疾病患者BALF和血清GM水平无明显差异。BALF GM的临界值为0.87,灵敏度为91.7%,特异度为92.5%,Youden指数为0.842。IPA患者BALF GM阳性率高于血清GM(χ^(2)=42.659,P<0.001)。Pearson分析显示,IPA组BALF和血清GM呈较弱正相关(r=0.296,95%CI:0.170~0.412,P<0.001)。BALF GM灵敏度为91.7%,特异度为92.5%;血清GM灵敏度为16.7%,特异度为98.5%;双阳性的灵敏度为8.3%,特异度为99.3%;BALF和血清任一阳性的灵敏度为99.6%,特异度为91.8%。结论 BALF GM检测的临界值为0.87,对IPA的诊断灵敏度高于血清GM检测,不同的组合可以侧重于提高检测的灵敏度或特异度。

TB-RNA、TB-DNA、基因芯片技术检测BALF对儿童涂阴肺结核的早期诊断价值

目的评估结核菌核糖核酸(tuberculosis bacterium ribonucleic acid,TB-RNA)、结核菌脱氧核糖核酸(tuberculosis bacterium deoxyribonucleic acid,TB-DNA)、基因芯片技术检测支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)对儿童涂阴肺结核的早期诊断价值。方法收集2019年1月至2022年8月于福建省福州肺科医院住院的227例0~17岁疑似涂阴肺结核患儿的BALF,进行TB-RNA、TB-DNA、基因芯片检测,分析三种检测方法的诊断效能。结果诊断为肺结核168例,非肺结核59例。以临床综合诊断(composite reference standard,CRS)为金标准,三种方法单独检测及联合检测BALF的敏感度分别为40.48%、39.29%、38.69%、56.55%,特异度分别为98.31%、96.61%、100%、94.92%,曲线下面积(Area under the curve,AUC)分别为0.694、0.679、0.693、0.757,单独检测的敏感度与培养法(44.64%)比较,差异均无统计学意义(χ^(2)分别为1.24,1.73,2.53,P均>0.05),联合检测的敏感度高于培养法及单独检测,差异均有统计学意义(χ^(2)分别为9.52,25.04,27.03,28.03,P均<0.05);三种方法检测的敏感度BALF明显高于痰,差异均有统计学意义(χ^(2)分别为41.33,24.92,28.17,P均<0.05)。以培养结果阳性为金标准,BALF进行三种方法单独检测及联合检测的敏感度分别为76.00%、69.33%、72%、85.33%,特异度分别为98.31%、96.61%、100%、94.92%,阳性预测值(Positive predictive value,PPV)分别为98.28%、96.30%、100%、95.52%,阴性预测值(Negative predictive value,NPV)分别为76.32%、71.25%、73.75%、83.58%,Kappa值分别为0.72、0.64、0.69、0.79,AUC分别为0.872、0.830、0.860、0.901。结论TB-RNA、TB-DNA、基因芯片检测BALF可快速诊断涂阴肺结核,联合检测可以提高儿童涂阴肺结核的病原学诊断率。

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。

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。

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。

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。

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。