首页|超声支气管镜联合mNGS在吸收消散不佳肺炎病因诊断中的应用

超声支气管镜联合mNGS在吸收消散不佳肺炎病因诊断中的应用

The application of ultrasound bronchoscopy combined with mNGS in the etiological diagnosis of pneumonia with poor absorption and dissipation

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目的 探究超声支气管镜联合宏基因组二代测序技术(mNGS)在确定吸收消散不佳肺炎病因方面的临床价值.方法 回顾性收集2022年1月至2023年2月该院吸收消散不佳肺炎患者的临床资料,其中73例患者接受超声支气管镜引导下的经支气管针吸活检(EBUS-TBNA),36例患者接受经超声支气管下经引导鞘管肺活检术(EBUS-GS-TBLB).分析患者病因分布及检查相关并发症发生情况.结果 所有患者经超声支气管镜联合mNGS检查显示:良性病变占33.03%,主要为慢性炎症(9.17%)和感染性疾病(20.18%),结核为主要感染性疾病病因(7.34%);恶性病变占57.80%,主要为腺癌(28.44%);诊断阳性率为90.83%,未能明确诊断占9.17%.EBUS-TBNA联合mNGS与EBUS-GS-TBLB联合mNGS检查患者诊断阳性率无明显差异(94.52%vs.83.33%,P>0.05),少量出血、缺氧、气胸、复苏延迟等并发症发生率亦无明显差异(P>0.05),所有患者未见纵隔气肿、大血管损伤、休克、死亡等严重并发症.结论 超声支气管镜联合mNGS在诊断吸收消散不佳肺炎的病因方面具有诊断阳性率较高、并发症少等特点,有助于帮助临床医师尽早明确诊断,可能成为近年来呼吸系统疾病诊断的新方法.
Objective To explore the clinical value of ultrasound bronchoscopy combined with met-agenomic next-generation sequencing(mNGS)in the etiological diagnosis of pneumonia with poor absorption and dissipation.Methods The clinical data of the patients with pneumonia with poor absorption and dissipa-tion in this hospital from January 2022 to February 2023 were retrospectively collected.Among them,73 cases received the endobronchial ultrasound guided tranbronchial needle aspiration(EBUS-TBNA)and 36 cases re-ceived endobronchial ultrasound transbronchial lung biopsy using guide sheath(EBUS-GS-TBLB).The distri-bution of causes and incidence of examination related complications were analysed.Results The results of ul-trasound bronchoscopy combined with mNGS examination showed that the benign lesions accounted for 33.03%,mainly chronic inflammation(9.17%)and infectious disease(20.18%),and tuberculosis was the main cause of infectious diseases(7.34%).The malignant lesions accounted for 57.80%,mainly adenocarcinoma(28.44%).The diagnostic positive rate was 90.83%,and no definite diagnosis accounted for 9.17%.There was no statistically significant difference in the diagnostic positive rate between the patients receiving EBUS-TBNA combined with mNGS examination and the patients receiving EBUS-GS-TBLB combined with mNGS examination(94.52%vs.83.33%,P>0.05),and there was no statistically significant difference in the inci-dence rates of complications such as less bleeding,anoxia,pneumothorax and delayed resuscitation.No serious complications such as mediastinal emphysema,large vessel injury,shock and death were observed in all pa-tients.Conclusion Ultrasound bronchoscopy combined with mNGS has the characteristics of high diagnostic positive rate and few complications in the etiological diagnosis of pneumonia with poor absorption and dissipa-tion.It can help clinical physicians clarify the diagnosis as soon as possible,and may become a new method for diagnosing respiratory system diseases in recent years.

endobronchial ultra soundmetagenomic next generation sequencingpneumonia with poor absorption and dissipationpathogen

赵启全、莫兰英

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重庆医科大学附属大足医院/重庆市大足区人民医院呼吸与危重症医学科,重庆 402360

超声支气管镜 宏基因组二代测序技术 吸收消散不佳肺炎 病原体

重庆市科卫联合医学科研项目

2022MSXM103

2024

重庆医学
重庆市卫生信息中心,重庆市医学会

重庆医学

CSTPCD
影响因子:1.797
ISSN:1671-8348
年,卷(期):2024.53(2)
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