mNGS在肺部感染病原学中的诊断价值及应用分析

Diagnostic value and application of mNGS in etiology of pulmonary infection

摘要:

目的 探讨宏基因组新一代测序（mNGS）在肺部感染病原体中的诊断价值及应用分析。方法 选取2022年1月至2022年12月孝感市中心医院呼吸与危重症医学科收治的肺部感染（由常见的院内细菌如金黄色葡萄球菌、肺炎克雷伯杆菌、铜绿假胞单菌、大肠埃希菌、鲍曼不动杆菌等，病毒如单纯疱疹病毒、人类疱疹病毒7型等，真菌如白色念珠菌、曲霉菌等引起）患者258例作为研究对象。分别采集患者的肺泡灌洗液标本进行病原微生物mNGS检测与常规痰培养的检测，评估mNGS的诊断价值与应用分析。结果 纳入研究的258例患者中，有200例患者通过mNGS检测得出，检出率为77.52％。有58例患者进行常规痰培养检测得出，检出率为22.48％。由此得出mNGS检测的病原微生物总检出率高于进行常规痰培养检测（P<0.05）。结论 mNGS对肺部感染患者的病原微生物检出率高于常规痰培养检测，应用价值较高。但是具有一定的局限性。mNGS无法确定它所检测的序列是来自活菌还是死菌，同时也不能区分定植菌与致病菌。另外，mNGS的费用较高，临床上可酌情使用。

Abstract:

Objective To investigate the diagnostic value and application of high-throughput sequencing (mNGS) in pulmonary infection pathogens.Methods A total of 258 patients with pulmonary infections (common gram-negative bacilli such as Staphylococcus aureus, Kleptobacillus pneumoniae, pseudomonas aeruginosa, Escherichia coli, acinetobacter baumannii, common viruses such as herpes simplex virus, Epstein-Barr virus, etc., common fungi such as candida albicans, Aspergillus, etc.) admitted to the Department of Respiratory and Critical Care Medicine of Xiaogan Central Hospital from January 2022 to December 2022 were selected. The patients' alveolar lavage fluid samples were collected for mNGS detection and routine sputum culture detection of pathogenic microorganisms, respectively, to evaluate the clinical application value of mNGS.Results Among the 258 patients included in the study, 200 patients were detected by mNGS, with a detection rate of 77.52%. There were 58 patients who underwent routine sputum culture detection, the detection rate was 22.48%. In conclusion, the total detection rate of pathogenic microorganisms detected by mNGS was significantly higher than that by conventional sputum culture detection, and the difference was statistically significant (P<0.05).Conclusion The detection rate of pathogenic microorganisms by mNGS in patients with pulmonary infection is significantly higher than that by conventional sputum culture detection, and the application value is higher. But relatively speaking, it has certain limitations. mNGS cannot determine whether the sequence it detects is from live or dead bacteria, nor can it distinguish between custom and pathogenic bacteria. In addition, the cost of mNGS is high, and it can be used as appropriate in clinic.