肺炎患者上下呼吸道样本多病原检测比较分析

目的 比较肺炎患者鼻咽拭子(nasopharyngeal swab,NPS)和支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)的病原学差异和诊断价值。方法 收集126例肺炎患者NPS及BALF,阵列qRT - PCR法检测42种病原体,进行多病原联合检测并进行分析。结果 126例患者BALF和NPS的病原阳性率分别为61.11%和46.03%,检出率差异均有统计学意义（χ2 = 5.76,P＜0.05）;BALF病毒检出率为33.53%,NPS病毒检出率为30.54%,差异无统计学意义（χ2 = 0.12, P＞0.05）,腺病毒（Adenovirus, AdV）检出一致性较好（Kappa = 0.57）;BALF与NPS的细菌检出率分别为35.71%和20.96%,二者检出率差异具有统计学意义（χ2 = 7.08,P＜0.05）,肺炎克雷伯菌（Klebsiella pneumoniae,K.P）的检出一致性较好（Kappa = 0.61）;BALF中肺炎支原体（Mycoplasma pneumoniae,MP）检出率（8.73%）高于NPS检出率（1.58%）,差异具有统计学意义（χ2 = 6.57,P＜0.05）。结论 NPS病原学检测可为肺炎诊断提供参考依据,NPS与BALF联合检测可提高病原检出率,增加诊断依据,但不认为NPS可以代替下呼吸道感染情况。推荐细菌性及支原体肺炎患者采集BALF检测病原,而病毒性肺炎患者可采集NPS进行病原检测。

Comparative analysis of multiple pathogen detection in upper and lower respiratory tract samples of patients with pneumonia

Objective To compare the etiological differences and diagnostic value of nasopharyngeal swab(NPS) and bronchoalveolar lavage fluid (BALF) in patients with pneumonia. Methods NPS and BALF were collected from 126 patients with pneumonia, and 42 pathogens were detected by array qRT-PCR. Multiple pathogens were detected and analyzed. Results The positive rates of BALF and NPS in 126 patients were 61.11% and 46.03%, respectively, with significant difference (χ2=5.76, P<0.05). The positive rates of BALF virus and NPS virus were 33.53% and 30.54%, without significant difference (χ2=0.12, P>0.05). Adenovirus (AdV) detection in NPS and BALF was of good consistency (Kappa=0.57). The bacterial detection rates of BALF was 35.71%, which was higher than that of NPS 20.96%, with significant difference (χ2=7.08, P<0.05). Klebsiella pneumoniae (K.P) detection in NPS and BALF was of good consistency (Kappa=0.61). The detection rate of Mycoplasma pneumoniae(MP) in BALF was 8.73%, which was higher than that of NPS(1.58%), with significant difference (χ2=6.57, P<0.05). Conclusion NPS pathogenic testing can provide a reference for the diagnosis of pneumonia, and combined NPS and BALF testing can improve the pathogen detection rate and increase the diagnostic basis, but NPS is not considered to be a substitute for lower respiratory tract infection conditions. It is recommended that BALF be collected for pathogen detection in patients with bacterial and mycoplasma pneumonia, while NPS can be collected for pathogen detection in patients with viral pneumonia.