肺泡灌洗液病原微生物宏基因组二代测序(mNGS)对社区获得性肺炎患儿病情严重程度的诊断价值

Diagnostic value of metagenomic next-generation sequencing (mNGS) of pathogenic microorganisms in bronchoalveolar lavage fluid for the severity of community-acquired pneumonia in children

摘要

目的 探究肺泡灌洗液病原微生物宏基因组二代测序(mNGS)对社区获得性肺炎(CAP)患儿病情严重程度的诊断价值。方法 选取2022年8月至2024年8月荆门市人民医院疑似社区获得性肺炎患儿138例行回顾性分析,均行肺泡灌洗液病原微生物mNGS检测与传统痰培养,以临床诊断为金标准[CAP为106例,其中重症社区获得性肺炎(SCAP)69例],比较mNGS检查、传统痰培养诊断CAP的价值、病原体感染率的差异,并分析基于mNGS检查的不同病情CAP患儿病原体感染状况。结果 以临床诊断作为金标准,mNGS检查诊断CAP的准确率为81.16%(112/138);传统痰培养诊断CAP的准确率为42.03%(58/138);mNGS检查诊断CAP准确率高于传统痰培养诊断准确率(χ²=44.662,P＜0.05)。两种检查方式检测主要细菌病原为铜绿假单胞菌,主要真菌病原为非孢子菌属,主要病毒病原为单纯疱疹病毒1型(HSV-1),主要衣原体病原为沙眼衣原体。相较于传统痰培养,mNGS检查检出单一感染率、混合感染率、细菌感染率、病毒感染率、真菌感染率、衣原体感染率更高(χ²介于7.072到106.388之间,P＜0.05)。相较于非SCAP组,SCAP组混合感染率、细菌+真菌+病毒感染率均更高,单一感染率更低(χ²=3.855、5.699,P＜0.05)。结论 肺泡灌洗液病原微生物mNGS诊断社区获得性肺炎患儿具有较好价值,且mNGS检测结果中的病原体感染特征与病情严重程度相关,mNGS可通过揭示混合感染的模式为临床评估社区获得性肺炎患儿病情严重程度提供参考依据。

Abstract

Objective To explore the diagnostic value of metagenomic next-generation sequencing (mNGS) of pathogenic microorganisms in bronchoalveolar lavage fluid for the severity of community-acquired pneumonia (CAP) in children. Methods A retrospective analysis was conducted on 138 children with suspected community-acquired pneumonia in Jingmen People's Hospital from August 2022 to August 2024. All patients underwent mNGS detection of pathogen in pulmonary alveolar lavage fluid and traditional sputum culture. The clinical diagnosis was used as the gold standard [106 cases of CAP, including 69 cases of severe community-acquired pneumonia (SCAP)]. The value of mNGS examination and traditional sputum culture in diagnosing CAP was compared, as well as the differences in the infection rate of pathogens. The infection status of pathogens in CAP children with different conditions based on mNGS examination was analyzed. Results With the clinical diagnosis as the gold standard, the accuracy of mNGS examination in diagnosing CAP was 81.16% (112/138); the accuracy of traditional sputum culture in diagnosing CAP was 42.03% (58/138); the accuracy of mNGS examination in diagnosing CAP was higher than that of traditional sputum culture (χ²=44.662, P＜0.05). The main bacterial pathogens detected by both examination methods were pseudomonas aeruginosa, the main fungal pathogens were non-spore-forming fungi, the main viral pathogens were herpes simplex virus type 1 (HSV-1), and the main chlamydial pathogens were chlamydia trachomatis. Compared with traditional sputum culture, mNGS examination detected a higher rate of single infection, mixed infection, bacterial infection, viral infection, fungal infection, and chlamydial infection (χ² values ranging from 7.072 to 106.388, P＜0.05). Compared with the non-SCAP group, the mixed infection rate, bacterial + fungal + viral infection rate, single infection rate were higher in the SCAP group (χ²=3.855, 5.699, P＜0.05). Conclusion The mNGS of pathogenic microorganisms in bronchoalveolar lavage fluid has a good value in the diagnosis of children with community-acquired pneumonia, and the characteristics of pathogen infection in the mNGS test results are related to the severity of the disease. The mNGS can provide a reference for clinical evaluation of the severity of children with community-acquired pneumonia by revealing the pattern of mixed infection.

关键词

儿童 / 社区获得性肺炎 / 宏基因组二代测序 / 肺泡灌洗液 / 病原微生物 / 病情程度 / 诊断价值

Key words

child / community-acquired pneumonia / metagenomic next-generation sequencing / bronchoalveolar lavage fluid / severity of disease / diagnostic value

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基金资助

荆门市科学技术研究与开发计划项目(2023YFYB037)