摘要
目的探讨通过支气管肺泡灌洗液(BALF)应用靶向高通量测序技术(tNGS)在肺部感染性疾病中发现老年人肺结核的诊断价值。方法采用横断面研究, 分析上海德济医院2021年1月至2023年7月收治的肺部感染性疾病患者370例的临床资料, 经支气管镜检留取BALF样本370份, 通过tNGS确诊肺结核患者28例。通过电子病案系统调取28例患者的临床资料, 分析患者年龄、临床特征、合并疾病、发现方式、影像学表现及病原学检测结果。结果患者年龄范围70~93岁, 中龄组(> 70~80岁)16例, 高龄组(> 80岁)12例;临床表现:乏力9例(32.1%), 咳嗽、咳痰8例(29.6%), 胸闷4例(14.3%), 食欲减退4例(14.3%), 体质量减轻3例(10.7%);合并糖尿病12例, 合并肺部感染性疾病10例, 合并肺癌4例, 合并肝肾功能不全2例;均通过tNGS检测被动确诊肺结核;影像学表现累及2个及以上多肺野病变24例(85.7%), 与累及单肺野4例(14.3%)相比差异有统计学意义(χ^(2)=25.79, P<0.001);28例患者传统病原学检测阳性率为14.3%, 与BALF tNGS相比, 差异有统计学意义(χ^(2)=68.55, P<0.001)。结论老年人肺结核起病隐匿, 合并症多导致临床症状及影像学无特异性, 病原学阳性检出率低, 非结核病定点医院在呼吸道感染性疾病中开展支气管BALF tNGS能提高老年肺结核患者的阳性检出率, 为老年人肺结核的早诊、早治及防止传播提供帮助。
Objective To evaluate the value of applying targeted next-generation sequencing on bronchoalveolar lavage fluid specimens in screening pulmonary tuberculosis in older adults with lung infectious diseases.Methods In this cross-sectional study,the clinical data of 370 patients with infectious lung diseases who received treatment at Shanghai Deji Hospital between January 2021 and July 2023 were analyzed.Bronchoscopy was performed to obtain 370 bronchoalveolar lavage fluid specimens,and targeted next-generation sequencing confirmed the diagnosis of pulmonary tuberculosis in 28 patients.The clinical data of these 28 patients were retrieved from the electronic medical record system.Patient age,clinical characteristics,comorbidities,methods of diagnosis,imaging findings,and results of pathogen testing were analyzed.Results The patients'ages ranged from 70 to 93 years.Among the 28 patients included,16 patients were in the medium-age(>70-80 years)group and 12 patients were in the advanced age(>80 years)group.Clinical findings revealed that 9 patients(32.1%)exhibited fatigue,8 patients(29.6%)presented with cough and sputum,4 patients(14.3%)experienced chest tightness,4 patients(14.3%)had loss of appetite,and 3 patients(10.7%)showed a reduction in body mass.Furthermore,12 patients had diabetes mellitus,10 patients had infectious lung diseases,4 patients had lung cancer,and 2 patients had liver and kidney insufficiency.Tuberculosis was passively confirmed by the targeted next-generation sequencing test.Imaging findings indicated the presence of two or more lesions in the lungs of 24 patients(85.7%),while 4 patients(14.3%)showed only one lesion in the lung.There was a significant difference between the number of patients with two or more lesions compared with those with only one lung lesion(χ^(2)=25.79,P<0.001).The positive rate of the conventional pathogen test among the 28 patients was 14.3%,which was significantly different from that obtained by targeted next-generation sequencing on bronchoalveolar lavage fluid specimens(χ^(2)=68.55,P<0.001).Conclusion The onset of pulmonary tuberculosis in older adults is subtle,and its complications can result in clinical symptoms and imaging findings that lack specificity.Conventional methods of positive etiology detection often yield low accuracy rates.However,the application of targeted next-generation sequencing on bronchial bronchoalveolar lavage fluid specimens collected from older adult patients with respiratory infectious diseases at non-tuberculosis-designated hospitals can enhance the positive detection rate.This approach can facilitate earlier diagnosis and treatment of pulmonary tuberculosis in older adults,ultimately contributing to the prevention of its transmission.
作者
马永贞
程东帅
陆月明
Ma Yongzhen;Cheng Dongshuai;Lu Yueming(Department of Respiratory Medicine,Shanghai Deji Hospital,Shanghai Clinical Medical College of Qingdao University,Shanghai 200030,China)
出处
《中国基层医药》
CAS
2024年第7期961-964,共4页
Chinese Journal of Primary Medicine and Pharmacy
关键词
结核
肺
呼吸道感染
支气管镜检查
支气管肺泡灌洗液
高通量核苷酸序列分析
诊断
老年人
Tuberculosis,pulmonary
Respiratory tract infections
Bronchoscopy
Bronchoalveolar lavage fluid
High-throughput nucleotide sequencing
Diagnosis
Aged
