tNGS对肺炎患者痰液/肺泡灌洗液标本病原体检测的影响及指导抗生素治疗的价值

Impact of targeted next-generation sequencing on pathogen detection in sputum/bronchoalveolar lavage fluid samples from pneumonia patients and its role in guiding antibiotic therapy

摘要:

目的 分析靶向病原高通量测序（tNGS）对肺炎患者痰液/肺泡灌洗液标本病原体检测的影响及其指导抗生素治疗的价值。方法 选取2022年3月—2024年3月石家庄市第二医院收治的125例肺炎患者为研究对象，采集痰液/肺泡灌洗液标本进行病原体培养检测和tNGS检测。比较2种方法的检测时间、检测结果。分析病原体培养检测与tNGS检测结果的一致性。比较不同性别、不同年龄段、不同病情程度、有无肺部基础疾病患者的tNGS检测结果。结果 tNGS检测的检测时间短于病原体培养检测（P < 0.05）。病原体阳性构成比高于病原体培养检测（P < 0.05）。病原体培养检测与tNGS检测的一致性Kappa指数为0.510（P < 0.05）。不同性别、不同年龄段、不同病情程度、有无肺部基础疾病患者的tNGS检测的阳性率比较，差异均无统计学意义（P > 0.05）。结论 相较于病原体培养检测，tNGS检测肺炎患者痰液/肺泡灌洗液标本病原体阳性率高，能缩短检测时间，为临床抗生素治疗提供参考方向，帮助临床医师制订干预措施，有助于患者病情恢复。

Abstract:

Objective To analyze the impact of targeted next-generation sequencing (tNGS) on pathogen detection in sputum/bronchoalveolar lavage fluid (BALF) samples from pneumonia patients and its value in guiding antibiotic therapy.Methods This study included 125 pneumonia patients admitted between March 2022 and March 2024. Sputum/BALF samples were processed for microbiological culture and tNGS analysis. Turnaround time and detection rates were compared. Cohen's Kappa coefficient assessed agreement between methods, and subgroup analyses (gender, age, disease severity, underlying pulmonary diseases) were performed.Results tNGS had a shorter turnaround time (P < 0.05) and higher pathogen detection rate (P < 0.05) versus microbiological culture. Moderate agreement was observed (Kappa = 0.510, P < 0.05). No subgroup differences in tNGS positivity were found (P > 0.05).Conclusion tNGS improves pathogen detection efficiency in pneumonia, enabling timely antibiotic optimization and enhanced clinical management.