宏基因二代测序技术在肺部感染病原学检测中的应用价值

The Application Value of Metagenomic Next-Generation Sequencing Technology in the Etiological Detection of Pulmonary Infections

摘要: 目的：研究mNGS技术在不明原因肺部感染病原学中的诊断价值。方法：采集2022年8月14日至2024年6月1日期间于青岛大学附属医院就诊的不明原因肺部感染患者的支气管肺泡灌洗液(BALF)标本，分别进行mNGS及传统病原学检测，回顾性分析上述患者的临床资料及病原学检出情况，并应用SPSS 25.0统计软件进行数据分析。结果：104例患者中mNGS及传统病原学检测的阳性率分别为85.58%、34.62%，mNGS检测阳性率高于传统病原学检测(P < 0.05)。在检测混合感染方面，mNGS对于混合感染的检出率(23.07%)高于传统病原学检测(5.76%) (P < 0.05)。此外，mNGS共检出74种微生物(350株)，包括54种细菌(255株)、9种真菌(40株)、8种病毒(50株)及3种非典型病原体(5株)；传统病原学检测共检出19种微生物(47株)，包括14种细菌(24株)、5种真菌(23株)，未检出病毒及非典型病原体。此外，mNGS检测阳性率不受院前抗菌药物使用史的影响(P > 0.05)，而传统病原学检测其检出能力可能受抗菌药物影响而降低(P< 0.05)。结论：与传统的病原学检测相比，mNGS在肺部感染的病原学诊断中具有更高的阳性率和检测效能，尤其对于混合感染，mNGS具有明显优势，其相较于传统病原学检测对于抗菌药物使用史的患者仍有较高的病原检出能力，为精准抗感染治疗提供了理论依据。

Abstract: Objective: To study the diagnostic value of mNGS technology in the etiology of pulmonary infections of unknown cause. Methods: Bronchoalveolar lavage fluid (BALF) specimens of patients with unexplained pulmonary infection who visited the Affiliated Hospital of Qingdao University from August 14, 2022 to June 1, 2024 were collected. mNGS and traditional etiological tests were conducted respectively. The clinical data and etiological detection of the above patients were retrospectively analyzed, and data analysis was conducted using SPSS 25.0 statistical software. Results: Among the 104 patients, the positive rates of mNGS and traditional etiological detection were 85.58% and 34.62% respectively (P < 0.05). The positive rate of mNGS detection was higher than that of traditional etiological detection. In terms of detecting mixed infections, the detection rate of mNGS for mixed infections (23.07%) was higher than that of traditional etiological detection (5.76%) (P < 0.05). In addition, mNGS detected a total of 74 types of microorganisms (350 strains), including 54 types of bacteria (255 strains), 9 types of fungi (40 strains), 8 types of viruses (50 strains), and 3 types of atypical pathogens (5 strains). Traditional etiological testing detected a total of 19 types of microorganisms (47 strains), including 14 types of bacteria (24 strains) and 5 types of fungi (23 strains). No viruses or special pathogens were detected. Furthermore, the positive rate of mNGS detection was not affected by the history of pre-hospital use of antibacterial drugs (P > 0.05), while the detection ability of traditional etiological detection may be reduced due to the influence of antibacterial drugs (P < 0.05), and the difference is statistically significant. Conclusion: Compared with traditional etiological detection, mNGS has a higher positive rate and detection efficiency in the etiological diagnosis of pulmonary infections. Especially for mixed infections, mNGS has obvious advantages. Compared with traditional etiological detection, it still has a higher pathogen detection ability for patients with a history of using antibacterial drugs, providing a theoretical basis for precise anti-infection treatment.