陈炎城 朱旭华 曾汉华

【摘要】 目的：探究并比較环介导恒温扩增芯片法（LAMP）在重症肺炎病原菌检测中的应用价值。方法：收集2017年1-12月本院收治的87例重症肺炎患者的分泌物标本，包括深部痰液、支气管吸出物、肺泡灌洗液，同时实施LAMP十三联检与痰培养检查，观察两种检查方法病原菌检出情况，并对比病原菌检出阳性率。结果：87例标本中痰培养检查病原菌为22例（25.29%），以铜绿假单胞菌（31.82%）为主且为单一病原菌感染;LAMP十三联检显示阳性标本41例（47.13%），其中单一病原菌感染24例（27.59%），混合病原菌感染17例（19.54%），以耐甲氧西林金黄色葡萄球菌（31.25%）及肺炎克雷伯菌（18.75%）为主，20～60岁、>60岁人群均以耐甲氧西林金黄色葡萄球菌感染为主，不同年龄段结核分枝杆菌复合群感染比较，差异有统计学意义（P<0.05）;LAMP阳性率为47.13%，高于痰培养的25.29%（P<0.05），结核分枝杆菌复合群、肺炎衣原体及流感嗜血杆菌等部分病原菌痰培养未检测出。结论：在重症肺炎病原菌检测中，LAMP十三联检可为临床治疗提供可靠实验室诊断依据，患者以耐甲氧西林金黄色葡萄球菌感染为主，为提高检测准确率可根据实际情况联合其他检测方法，指导用药。

【关键词】 环介导恒温扩增芯片法; 痰培养; 重症肺炎; 病原菌

【Abstract】 Objective：To explore and compare the application value of loop-mediated isothermal amplification（LAMP）in pathogenic bacteria detection of severe pneumonia.Method：Secretion specimens of 87 patients with severe pneumonia admitted to our hospital from January 2017 to December 2017 were collected，it included deep sputum，bronchial aspirates and alveolar lavage fluid，at the same time，LAMP and sputum culture were carried out，the detection of pathogenic bacteria by two methods were observed，and the positive rate of pathogenic bacteria was compared.Result：Of 87 specimens，22 cases（25.29%）were pathogenic bacteria by sputum culture，pseudomonas aeruginosa（31.82%）was the main pathogen and only one pathogen was infected.LAMP showed that 41 cases（47.13%）positive specimens，including 24 cases（27.59%）of single pathogen infection，17 cases（19.54%）of mixed pathogen infection，mainly methicillin-resistant Staphylococcus aureus（31.25%）and Klebsiella pneumoniae（18.75%）.People aged 20-60 years and over 60 years were mainly methicillin-resistant Staphylococcus aureus infection，with tuberculosis branches in different age groups，there was significant difference in Bacillus complex infection（P<0.05），the positive rate of LAMP in lower was 47.13% higher than 25.29% in sputum culture（P<0.05），some pathogenic bacteria such as Mycobacterium tuberculosis complex，Chlamydia pneumoniae and Haemophilus influenzae were not detected in sputum culture.Conclusion：In the detection of pathogenic bacteria in severe pneumonia，LAMP can provide reliable laboratory diagnostic basis for clinical treatment，methicillin-resistant Staphylococcus aureus infection is the main pathogen in patients.In order to improve the detection accuracy，other detection methods can be combined according to the actual situation to guide drug use.

【Key words】 Loop-mediated isothermal amplification; Sputum culture; Severe pneumonia; Pathogenic bacteria

First-authors address：Meizhou Peoples Hospital，Meizhou 514000，China

doi：10.3969/j.issn.1674-4985.2019.17.043

重症肺炎是临床多发性疾病，发病急、进展快，以咳嗽、咳痰为主要临床症状，随着病情加重，甚至出现呼吸衰竭、多器官功能障碍等，具有较高死亡率，多数患者被确诊后将转入重症监护室（intensive care unit，ICU）救治，而选择有效抗菌药物是降低患者死亡率的关键问题[1-2]。但随着抗生素在临床治疗的广泛应用，耐药菌株增加将影响患者治疗效果，因而需及时准确分析病原菌构成，准确判断病情，给予合理抗生素药物，从而减少医疗费用，减轻治疗痛苦。痰培养是目前普遍应用的病原菌检测技术，但培养时间较长，易导致患者错过最佳治疗时机，效果欠佳[3]。环介导恒温扩增芯片法（loop-mediated isothermal amplification，LAMP）十三联检作为新型检测技术，操作简便快捷，并因敏感度及特异度较好而在病原菌检测中广泛应用[4]。为……