支气管镜肺泡灌洗液微生物检测技术在肺部 疾病诊断中的应用进展

Application Progress of Bronchoscopic Bronchoalveolar Lavage Fluid Microbiological Detection Technology in the Diagnosis of Pulmonary Diseases

摘要: 肺部疾病的病因向来复杂，临床上面临两个关键问题：一是感染与非感染性病变的鉴别，二是病原体的快速明确，这两点直接决定了治疗走向。支气管镜肺泡灌洗液(BALF)直接取自肺泡和小气道，能较好地避开上呼吸道菌群的干扰，反映下呼吸道的真实微生态和感染状况，因此在肺部疾病的病原学诊断中具有独特优势。过去，BALF的微生物检测主要依赖涂片和培养，但灵敏度低、耗时长、能检测的病原体种类有限。近年来，实时荧光定量PCR、数字PCR、宏基因组二代测序、靶向测序以及质谱技术等陆续进入临床，不仅明显提高了病原体检出率和诊断准确性，也在间质性肺疾病、肺癌等非感染性疾病的微生态研究中展现出潜力。本文就BALF微生物检测技术的发展、各类技术的特点、临床应用现状、存在的问题以及未来方向进行综述，希望能为临床精准诊疗提供一些参考。

Abstract: The etiologies of pulmonary diseases have always been complex. Clinically, there are two key challenges: the differentiation between infectious and non-infectious lesions, and the rapid identification of pathogens, both of which directly determine the treatment strategy. Bronchoalveolar lavage fluid (BALF) is directly collected from the alveoli and small airways, which can effectively avoid the interference of upper respiratory tract flora and reflect the real microecology and infectious status of the lower respiratory tract. Therefore, it possesses unique advantages in the etiological diagnosis of pulmonary diseases. In the past, the microbiological detection of BALF mainly relied on smear microscopy and microbial culture, which were limited by low sensitivity, long detection cycle and narrow coverage of detectable pathogens. In recent years, emerging technologies including real-time fluorescence quantitative PCR, digital PCR, metagenomic next-generation sequencing, targeted sequencing and mass spectrometry have been gradually applied in clinical practice. These techniques have significantly improved the pathogen detection rate and diagnostic accuracy, and also shown great potential in the microecological research of non-infectious pulmonary diseases such as interstitial lung disease and lung cancer. This article reviews the development of BALF microbiological detection technologies, the characteristics of various detection methods, current clinical application status, existing limitations and future research directions, so as to provide references for precise clinical diagnosis and treatment of pulmonary diseases.