摘要
目的探讨肺泡灌洗液(BALF)宏基因二代测序技术(mNGS)在诊断肿瘤重症患者重症肺炎(SP)中的临床应用价值。方法选取2020年7月至2022年8月期间江苏省肿瘤医院重症监护室42例SP患者,所有患者均进行BALF-mNGS检测和病原微生物培养,回顾性分析其临床特点、实验室检查、影像学检查及诊治过程,评价BALF-mNGS在诊断肿瘤重症患者SP的临床应用价值。结果42例患者中,传统病原微生物培养阳性24例(57.14%),其中混合感染6例(14.29%),共检出31株病原菌;BALF-mNGS检测阳性36例(85.71%),其中混合感染29例(69.05%),共检出148株病原菌;BALF-mNGS检测的阳性率与2种及以上病原菌感染检出率均高于传统病原微生物培养[85.71%(36/42)比57.14%(24/42),χ^(2)=8.400,P<0.05;69.05%(29/42)比14.29%(6/42),χ^(2)=25.910,P<0.05]。以传统培养为"金标准",BALF-mNGS检测的敏感度、特异度、阳性预测值及阴性预测值,结果分别为95.8%、27.8%、63.9%、83.3%。单因素分析显示,未见BALF-mNGS对病原菌检出率的影响因素存在(P>0.05)。结论在肿瘤重症患者SP中,BALF-mNGS对病原菌检出率高于传统培养方法,且干扰因素少,有助于指导肿瘤重症患者SP的诊断和治疗。
Objective To investigate the clinical application value of bronchial alveolar lavage fluid(BALF)metagenomic next generation sequencing(mNGS)in the diagnosis of severe pneumonia in cancer intensive care unit.Methods From July 2020 to August 2022,42 patients with severe pneumonia(SP)in the intensive care unit of Jiangsu Cancer Hospital were selected.All patients were subjected to BALF-mNGS testing and traditional microbial culture pathogen detection.The clinical features,laboratory tests,imaging examination,diagnosis,and treatment data were retrospectively analyzed,and the clinical value of BALF-mNGS in SP in patients with severe tumors was evaluated.Results Among the 42 patients,24 had positive results(57.14%)and 6 had mixed infections(14.29%)by traditional microbial culture with 31 strains of pathogen;however,36 patients had positive results(85.71%)and 29 had mixed infections(69.05%)by BALF-mNGS with 148 strains of pathogen.The positive rate of pathogens and the infection detection rate of more than 2 pathogensby BALF-mNGS were significantly higher than those by the traditional microbial culture[85.71%(36/42)vs.57.14%(24/42),χ^(2)=8.400,P<0.05;69.05%(29/42)vs.14.29%(6/42),χ^(2)=25.910,P<0.05].Taking the culture results as the gold standard,the sensitivity,specificity,positive predictive value and negative predictive value of BALF-mNGS were 95.8%,27.8%,63.9% and 83.3% respectively.The univariate analysis showed no factors influencing the detection of BALF-mNGS(P>0.05).Conclusion The detection rate of pathogenic bacteria by BALF-mNGS in SP of patients with severe tumors is higher than that of traditional culture methods.BALF-mNGS has with fewer interfering factors,and can help guide the diagnosis and treatment of SP of patients with severe tumors.
作者
洪慧
羌燕
姜斐
章艳
马曙亮
李明
张帅
Hong Hui;Qiang Yan;Jiang Fei;Zhang Yan;Ma Shuliang;Li Ming;Zhang Shuai(Department of Intensive Care Unit,the Affiliated Cancer Hospital of Nanjing Medical University,Jiangsu Cancer Hospital,Jiangsu Institute of Cancer Research,Nanjing 210009,China;Department of Thoracic Surgery,the Affiliated Cancer Hospital of Nanjing Medical University,Jiangsu Cancer Hospital,Jiangsu Institute of Cancer Research,Nanjing 210009,China)
出处
《中华实验外科杂志》
CAS
北大核心
2023年第1期149-152,共4页
Chinese Journal of Experimental Surgery
基金
国家自然科学基金面上项目(81872378)
江苏省肿瘤医院院内项目(ZH202109)。
关键词
肺泡灌洗液
宏基因二代测序技术
肿瘤
重症肺炎
Bronchial alveolar lavage fluid
Metagenomic next generation sequencing
Cancer
Severe pneumonia
