肺泡灌洗液二代基因测序对儿童重症肺炎病原学诊断应用观察

目的　探讨肺泡灌洗液二代基因测序（mNGS）在儿童重症肺炎病原学诊断中的应用。方法　回顾性分析2018年9月至2019年3月于吉林大学第一医院小儿呼吸二科住院治疗的34例重症肺炎患儿临床资料，收集其肺泡灌洗液进行mNGS结果分析。结果　34例中检出病原32例（94.1%）。单一病原体检出结果：肺炎支原体19例（55.9%），人类腺病毒7型6例（17.6%），福赛斯坦纳菌1例（2.9%），金黄色葡萄球菌1例（2.9%），未检出1例（2.9%）。混合感染病原体检出结果：人类腺病毒7型+肺炎支原体2例（5.9%），人类腺病毒7型+流感嗜血杆菌1例（2.9%），人类腺病毒7型+烟曲霉3例（8.8%）。经抗感染及对症支持治疗后，33例好转出院，1例死亡。结论　mNGS可提高重症肺炎的病原诊断准确率，对临床治疗有指导作用。

Application of alveolar lavage fluid mNGS in the etiological diagnosis of children with severe pneumonia

Objective　To explore the application of alveolar lavage fluid NGS in etiological diagnosis of children with severe pneumonia. Methods　The clinical data of 34 children with severe pneumonia hospitalized in Pediatric Respiratory Department from September 2018 to March 2019 were retrospectively analyzed. The collected alveolar lavage fluid was analyzed by metagenomics NGS. Results　Totally 34 cases were diagnosed as severe pneumonia. The results of mNGS：32 cases（94.1%） were detected in 34 samples，19 cases（55.9%） of Mycoplasma pneumoniae，6 cases（17.6%） of human adenovirus type 7，1 case（2.9%） of Forsystanella，1 case of Staphylococcus aureus（2.9%）；1 cases（2.9%） was not detected，and the positive rate of Mycoplasma pneumoniae was the highest. The mixed infection showed human adenovirus type 7+ Mycoplasma pneumoniae in 2 cases（5.9%），human adenovirus type 7+ Haemophilus influenzae in 1 case（2.9%） and human adenovirus type 7+ Aspergillus fumigatus in 3 cases（8.8%）. After anti-infection and symptomatic support treatment，33 cases were improved and discharged，and 1 case died. Conclusion　The metagenomics NGS can improve the diagnostic accuracy of the pathogen in severe pneumonia，and early and accurate identification of the pathogen plays an important role in guiding the rational use of antibiotics in clinical practice.