摘要
目的探究超声支气管镜联合宏基因组二代测序技术(mNGS)在确定吸收消散不佳肺炎病因方面的临床价值。方法回顾性收集2022年1月至2023年2月该院吸收消散不佳肺炎患者的临床资料,其中73例患者接受超声支气管镜引导下的经支气管针吸活检(EBUS-TBNA),36例患者接受经超声支气管下经引导鞘管肺活检术(EBUS-GS-TBLB)。分析患者病因分布及检查相关并发症发生情况。结果所有患者经超声支气管镜联合mNGS检查显示:良性病变占33.03%,主要为慢性炎症(9.17%)和感染性疾病(20.18%),结核为主要感染性疾病病因(7.34%);恶性病变占57.80%,主要为腺癌(28.44%);诊断阳性率为90.83%,未能明确诊断占9.17%。EBUS-TBNA联合mNGS与EBUS-GS-TBLB联合mNGS检查患者诊断阳性率无明显差异(94.52%vs.83.33%,P>0.05),少量出血、缺氧、气胸、复苏延迟等并发症发生率亦无明显差异(P>0.05),所有患者未见纵隔气肿、大血管损伤、休克、死亡等严重并发症。结论超声支气管镜联合mNGS在诊断吸收消散不佳肺炎的病因方面具有诊断阳性率较高、并发症少等特点,有助于帮助临床医师尽早明确诊断,可能成为近年来呼吸系统疾病诊断的新方法。
Objective To explore the clinical value of ultrasound bronchoscopy combined with metagenomic next-generation sequencing(mNGS)in the etiological diagnosis of pneumonia with poor absorption and dissipation.Methods The clinical data of the patients with pneumonia with poor absorption and dissipation in this hospital from January 2022 to February 2023 were retrospectively collected.Among them,73 cases received the endobronchial ultrasound guided tranbronchial needle aspiration(EBUS-TBNA)and 36 cases received endobronchial ultrasound transbronchial lung biopsy using guide sheath(EBUS-GS-TBLB).The distribution of causes and incidence of examination related complications were analysed.Results The results of ultrasound bronchoscopy combined with mNGS examination showed that the benign lesions accounted for 33.03%,mainly chronic inflammation(9.17%)and infectious disease(20.18%),and tuberculosis was the main cause of infectious diseases(7.34%).The malignant lesions accounted for 57.80%,mainly adenocarcinoma(28.44%).The diagnostic positive rate was 90.83%,and no definite diagnosis accounted for 9.17%.There was no statistically significant difference in the diagnostic positive rate between the patients receiving EBUS-TBNA combined with mNGS examination and the patients receiving EBUS-GS-TBLB combined with mNGS examination(94.52%vs.83.33%,P>0.05),and there was no statistically significant difference in the incidence rates of complications such as less bleeding,anoxia,pneumothorax and delayed resuscitation.No serious complications such as mediastinal emphysema,large vessel injury,shock and death were observed in all patients.Conclusion Ultrasound bronchoscopy combined with mNGS has the characteristics of high diagnostic positive rate and few complications in the etiological diagnosis of pneumonia with poor absorption and dissipation.It can help clinical physicians clarify the diagnosis as soon as possible,and may become a new method for diagnosing respiratory system diseases in recent years.
作者
赵启全
莫兰英
ZHAO Qiquan;MO Lanying(Department of Respiratory and Critical Care Medicine,The Affiliated Dazu’s Hospital of Chongqing Medical University/The People’s Hospital of Dazu,Chongqing 402360,China)
出处
《重庆医学》
CAS
2024年第2期193-197,共5页
Chongqing medicine
基金
重庆市科卫联合医学科研项目(2022MSXM103)。
关键词
超声支气管镜
宏基因组二代测序技术
吸收消散不佳肺炎
病原体
endobronchial ultra sound
metagenomic next generation sequencing
pneumonia with poor absorption and dissipation
pathogen
