肺泡灌洗液快速现场评价联合宏基因组二代测序在重症肺炎患者中的应用价值
Application Value of Rapid On-site Evaluation of Alveolar Lavage Fluid Combined with Metagenomic Next-generation Sequencing in Patients with Severe Pneumonia
刘亚萌 1李冠英 1刘翠 1朱劲松 1张胜利 1梁希军1
作者信息
- 1. 061000 河北 沧州,沧州市人民医院呼吸内科
- 折叠
摘要
目的 探讨肺泡灌洗液快速现场评价(ROSE)联合宏基因组二代测序(mNGS)在重症肺炎患者中的应用价值.方法 筛选2021 年10 月至2024 年4 月治疗的94 例重症肺炎患者进行前瞻性研究,随机分为对照组(常规病原学检查)47 例与观察组(ROSE联合mNGS技术进行病原学检查)47 例,均给予抗生素治疗.记录 2 组肺泡灌洗液有效病原体检出率、抗生素应用情况、发热时间、机械通气时间、住重症监护室时间,比较2 组入院第1、4、7 天临床肺部感染评分(CPIS)以及血清C反应蛋白(CRP)、降钙素原(PCT)水平.结果 观察组肺泡灌洗液有效病原体检出率为97.87%(46/47),高于对照组的59.57%(28/47,P＜0.05),且观察组可检出病毒及不常见病原体(如鹦鹉热衣原体、结核分枝杆菌、堪萨斯分枝杆菌).与对照组比较,观察组抗生素使用时间、发热时间、机械通气时间、住重症监护室时间均较短,抗生素使用种类及调整频次较少(P＜0.05).2 组入院第4、7 天CPIS及血清CRP、PCT水平均较入院第1 天降低,且随着治疗时间的增加而降低(P＜0.05);与对照组比较,观察组入院第 4、7 天CPIS及外周血CRP、PCT水平均降低(P＜0.05).结论 ROSE联合mNGS技术在重症肺炎患者中有较高的应用价值,可提高病原学检出率,及时明确病原体,从而快速指导临床精准治疗.
Abstract
Objective To investigate the application value of rapid on-site evaluation(ROSE)of alveolar lavage flu-id combined with metagenomic next-generation sequencing(mNGS)in patients with severe pneumonia.Methods A pro-spective study was conducted on 94 patients with severe pneumonia treated from October 2021 to April 2024,and they were randomly divided into the control group(routine etiological examination,n=47)and the observation group(ROSE combined with mNGS technology for etiological examination,n=47),all of whom were given antibiotics.The effective pathogen detec-tion rate of alveolar lavage fluid,antibiotic application,fever time,duration of mechanical ventilation and intensive care unit(ICU)stay were recorded in the two groups,and the clinical pulmonary infection score(CPIS)and serum peripheral blood C-reactive protein(CRP)and procalcitonin(PCT)levels were compared between the two groups at 1,4 and 7 d after admis-sion.Results The effective pathogen detection rate of alveolus lavage fluid in the observation group was 97.87%(46/47),which was higher than that of the control group[59.57%(28/47)](P＜0.05),and viruses and uncommon pathogens(such as chlamydia pectin,Mycobacterium tuberculosis,Mycobacterium kansans)could be detected in the observation group.Compared with the control group,the time of antibiotic use,fever time,duration of mechanical ventilation and length of ICU stay in the observation group were shorter,and the types of antibiotics used and the frequency of adjustment were less(P＜0.05).The levels of CPIS,serum CRP and PCT in peripheral blood of the two groups on the 4th and 7th day after admission were lower than those on the 1st day,and decreased with the increase of treatment time(P＜0.05).Compared with the con-trol group,CPIS score,CRP and PCT levels in peripheral blood of the observation group were decreased on the 4th and 7th day after admission(P＜0.05).Conclusion ROSE combined with mNGS technology has a high application value in pa-tients with severe pneumonia,which can improve the etiological detection rate and identify the pathogen in time,so as to rap-idly guide clinical precision treatment.
关键词
重症肺炎/快速现场评价/宏基因组二代测序/病原体/肺泡灌洗液/临床肺部感染评分/C反应蛋白/降钙素原Key words
Severe pneumonia/Rapid on-site evaluation/Metagenomic next-generation sequencing/Pathogen/Alve-olar lavage fluid/Clinical pulmonary infection score/C reactive protein/Procalcitonin引用本文复制引用
出版年
2025
国家科技期刊平台
NSTL
万方数据