目的: 探究肺泡灌洗液宏基因组测序（metagenomic next-generation sequencing,mNGS）及炎性因子水平在新生儿重症肺炎诊断及预后评估中的应用价值。方法: 回顾性分析2022年5月—2023年5月于我院治疗的200例重症肺炎新生儿作为观察组,同期收集100例健康儿童作为对照组。记录肺泡灌洗液宏基因组测序结果检出率,对比观察组肺泡灌洗液炎症因子水平与对照组血清炎症因子水平差异。再对比不同预后新生儿的肺泡灌洗液炎症因子水平,分析预后评估价值。结果: mNGS未检出率低于常规检测,混合感染检出率高于常规检测。观察组肺泡灌洗液炎症因子水平均高于对照组血清炎症因子水平。预后不良组肺泡灌洗液炎症因子水平均高于预后良好组;经ROC分析,肺泡灌洗液炎症因子水平对预后预测的曲线下面积分别为0.780、0.835、0.853、0.804、0.813。结论: 肺泡灌洗液宏基因组测序对重症肺炎新生儿的诊断价值较高,且肺泡灌洗液炎症因子水平能评估预后效果,可作为临床病情诊断及预后评估的辅助检查。
Abstract
Objective To explore the application value of metagenomic next-generation sequencing (mNGS) in alveolar lavage fluid and inflammatory factors in the diagnosis and prognosis evaluation of neonates with severe pneumonia. Methods A total of 200 neonates with severe pneumonia in the hospital and 100 healthy children were retrospectively enrolled as observation group and control group between May 2022 and May 2023, respectively. The detection rates of mNGS results were recorded. The differences in inflammatory factors of alveolar lavage fluid in observation group and serum inflammatory factors in control group were compared. The levels of inflammatory factors in alveolar lavage fluid among neonates with different prognosis were compared, and their evaluation value in prognosis was analyzed. Results The undetected rate by mNGS was lower than that by routine detection, and detected rate of mixed infection was higher than that by routine detection (P<0.05). The levels of inflammatory factors in alveolar lavage fluid in observation group were higher than serum inflammatory factors in control group (P<0.05). The levels of inflammatory factors in alveolar lavage fluid in poor prognosis group were higher than those in good prognosis group (P<0.05). ROC curves analysis showed that area under the curve (AUC) values of inflammatory factors in alveolar lavage fluid for predicting neonatal prognosis were 0.780, 0.835, 0.853, 0.804 and 0.813, respectively (P<0.05). Conclusion The mNGS in alveolar lavage fluid has high diagnostic value in neonates with severe pneumonia, and inflammatory factors in alveolar lavage fluid can effectively evaluate neonatal prognosis, which can be used as an auxiliary method for clinical diagnosis and prognosis evaluation of the disease.
关键词
新生儿 /
重症肺炎 /
肺泡灌洗液 /
宏基因组测序 /
炎性因子
Key words
neonate /
severe pneumonia /
alveolar lavage fluid /
metagenomic next-generation sequencing /
inflammatory factor
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基金
青海省卫生健康委员会计划“宏基因组测序在新生儿重症肺炎诊断及预后评估中的应用价值研究”（2021-Wjzdx-65）
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