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肺泡灌洗液mNGS在肺部感染性疾病中的应用价值研究
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Abstract:
目的：分析肺泡灌洗液(BALF)宏基因二代测序技术(mNGS)在社区获得性肺炎及支气管扩张合并肺部感染两种常见肺部感染性疾病中的应用价值。方法：对2022年10月14日至2023年6月21日于青岛大学附属医院住院治疗的138例肺部感染患者进行回顾性分析，包括106例社区获得性肺炎患者与32例支气管扩张合并肺部感染患者的临床资料；分析两种疾病BALFmNGS病原学检出阳性率、病原体分布情况、与传统病原学培养一致率、不同临床特征与BALFmNGS阳性检出率的相关性及治疗方案变更情况。结果：BALFmNGS病原学检出阳性率显著高于传统病原学培养(χ2 = 96.667, P < 0.001)，BALFmNGS病原体检出株数明显高于传统病原学培养，在BALFmNGS与传统病原学培养均阳性时，两种疾病mNGS结果均能大部分覆盖传统病原学培养，且两种疾病BALFmNGS覆盖率无显著差异(P > 0.05)。对于不同临床特征患者BALFmNGS病原体检出阳性率的比较中，仅预后情况有统计学意义(P < 0.05)，整体上，患者行mNGS后方案变更率为49.3%，且两组方案变更率无统计学差异(P > 0.05)。结论：应用BALFmNGS可以显著提高社区获得性肺炎及支气管扩张合并肺部感染两种常见感染性疾病的病原体检出率。BALFmNGS在两种疾病的病原体检出中都能够大部分覆盖传统病原学检查结果且大多数临床特征对于BALFmNGS的检出阳性率无明显相关性。此外，患者在行BALFmNGS之后约有一半的治疗方案发生变更。BALFmNGS在肺部感染的诊断及治疗中有较高的可靠性及临床应用价值。
Objective: To analyze the application value of broncho alveolar lavage fluid (BALF) metagenomics next generation sequencing (mNGS) in community acquired pneumonia and bronchiectasis with pulmonary infection, two common pulmonary infectious diseases. Method: A retrospective analysis was conducted on 138 hospitalized patients with pulmonary infections at Qingdao University Affili-ated Hospital from October 14, 2022 to June 21, 2023, including clinical data of 106 communi-ty-acquired pneumonia patients and 32 patients with bronchiectasis combined with pulmonary in-fections; analyze the positive rate of BALFmNGS pathogen detection, pathogen distribution, con-sistency with conventional pathogen culture, correlation between different clinical features and BALFmNGS positive detection rate, and changes in treatment plans for two diseases. Result: The positive rate of BALFmNGS pathogen detection was significantly higher than that of conventional pathogen culture (χ2 = 96.667, P < 0.001), the number of plants detected by BALFmNGS pathogen examination was significantly higher than that of conventional pathogen culture. When both BALFmNGS and conventional pathogen culture were positive, the mNGS results of both diseases could mostly cover conventional pathogen culture, and there was no significant difference in BALFmNGS coverage between the two diseases (P > 0.05). In the comparison of positive rates of BALFmNGS pathogen examination for patients with different clinical characteristics, only the prog-nosis was statistically significant (P < 0.05). Overall, the change rate of protocol after mNGS treat-ment was 49.3%, and there was no statistically significant difference in the change rate between the two groups (P > 0.05). Conclusion: The application of BALFmNGS can significantly improve the de-tection rate of pathogens of community
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