肺泡灌洗液宏基因组测序在儿童重症肺炎支原体肺炎混合感染中的诊断价值

doi:10.3969/j.issn.1000-3606.2020.12.003

临床儿科杂志 ›› 2020, Vol. 38 ›› Issue (12): 891-.doi: 10.3969/j.issn.1000-3606.2020.12.003

肺泡灌洗液宏基因组测序在儿童重症肺炎支原体肺炎混合感染中的诊断价值

马彩霞 1, 陈镜龙 2, 陆泳 2, 张明智 2, 王立波 2, 陆爱珍 2

1 . 复旦大学附属中山医院青浦分院儿科（上海 201700）； 2 . 复旦大学附属儿科医院（上海 201102）

出版日期:2020-12-15 发布日期:2020-12-18
通讯作者: 陆爱珍电子信箱：zal2008@163.com
基金资助:
上海市青浦区科委项目(No. QKY2019-16)；上海市科委西医引导项目（No.17411960700）

Diagnostic value of metagenomics next-generation sequencing of bronchalveolar lavage fluid for mixed infection in children with severe Mycoplasma pneumoniae pneumonia

MA Caixia1 , CHEN Jinglong2 , LU Yong2 , ZHANG Mingzhi2 , WANG Libo2 , LU Aizhen2

1 .Pediatric department of Qingpu Branch of Zhongshan Hospital, Fudan University Respiratory department, Shanghai 201700, China;2 .Department of Pneumology, Children Hospital of Fudan University, Shanghai 201102 , China

Online:2020-12-15 Published:2020-12-18

摘要/Abstract

摘要： 目的探讨肺泡灌洗液（BALF）宏基因组二代测序技术对儿童重症肺炎支原体肺炎（MPP）混合感染的诊断价值。方法选取2019年6月至2019年12月期间因重症MPP需要肺泡灌洗治疗的患儿，所得BALF同时进行传统病原检测和宏基因组的二代测序（metagenomics next-generation sequencing，mNGS）病原检测，分析两种检测方法对重症MPP 混合感染的诊断效能。结果共纳入47例重症肺炎支原体肺炎患儿，男23例、女24例，中位年龄58.0（38.0~81.0）月。影像学有肺实变/不张表现的患儿31例，胸腔积液10例，伴有纵隔积气2例。气管镜下有明显黏膜坏死、通气不良或者痰栓形成的患儿28例。47例患儿的BALF同时进行传统病原检测和mNGS检测，两种检测方法检出肺炎支原体均为阳性。 BALF传统病原检测中，2例（4.3%）检测出混合感染；mNGS检测中，23例（48.9%）检测出混合感染，显著高于传统病原检测，差异有统计学意义（P

关键词: 肺泡灌洗液；宏基因组测序；肺炎支原体肺炎；混合感染

Abstract: Objective To explore the diagnostic value of metagenomics next-generation sequencing (mNGS) of bronchalveolar lavage fluid (BALF) for mixed infection in children with severe Mycoplasma pneumoniae pneumonia (MPP). Methods From June 2019 to December 2019 , children with severe MPP who need bronchoalveolar lavage treatment were enrolled. BALF was detected by traditional pathogen detection and mNGS at the same time. BALFs were sent for traditional pathogen detection and metagenomics next-generation sequencing. The diagnostic efficacy of the two detection methods for the mixed infection in severe MPP was analyzed. Results A total of 47 ( 23 males and 24 females) children with severe MPP were enrolled and median age was 58 . 0 ( 38 . 0 ~ 81 . 0 ) months. Radiography showed pulmonary consolidation/atelectasis in 31 cases, pleural effusion in 10 cases, and pneumomediastinum in 2 cases. Bronchoscopy revealed that 28 children had obvious mucosal necrosis, poor ventilation, or phlegm formation. The BALF of 47 children was detected by both traditional pathogen detection and mNGS detection, and both methods detected that all children were Mycoplasma pneumoniae positive. Traditional pathogen detection of BALF found mixed infection in 2 cases (4.3%). By mNGS detection, mixed infection was found in 23 cases (48.9%), which was significantly higher than that in traditional pathogen detection. The difference was statistically significant (P< 0 . 001 ). The top three pathogens detected by mNGS were adenovirus type 7 ( 11 cases, 23 . 4 %), Streptococcus pneumoniae ( 5 cases) and Mycobacterium abscess ( 5 cases). Conclusions The BALF mNGS has a higher detection rate of mixed infection in pediatric severe MPP than traditional detection methods, especially for the detection of combined virus infection. It is helpful for early virus typing and viral load analysis.

Key words: bronchoalveolar lavage fluid;? metagenomic next-generation sequencing;? severe Mycoplasma pneumoniae pneumonia; mixed infection

马彩霞，陈镜龙，陆泳，等. 肺泡灌洗液宏基因组测序在儿童重症肺炎支原体肺炎混合感染中的诊断价值[J]. 临床儿科杂志, 2020, 38(12): 891-.

MA Caixia, CHEN Jinglong, LU Yong, et al. Diagnostic value of metagenomics next-generation sequencing of bronchalveolar lavage fluid for mixed infection in children with severe Mycoplasma pneumoniae pneumonia[J]. Journal of Clinical Pediatrics, 2020, 38(12): 891-.

肺泡灌洗液宏基因组测序在儿童重症肺炎支原体肺炎混合感染中的诊断价值

Diagnostic value of metagenomics next-generation sequencing of bronchalveolar lavage fluid for mixed infection in children with severe Mycoplasma pneumoniae pneumonia

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