周佳琦　马肖龙

[摘要] 目的 探討高通量基因序列（NGS）联合质谱分析在免疫抑制合并重症肺炎患者肺泡灌洗液感染病原中的应用效果及ROC曲线分析。 方法 选择2017年1月至2019年12月在我院治疗的免疫抑制合并重症肺炎患者50例为研究对象，随机分为对照组（25例）和观察组（25例），对照组予经验性广谱抗菌药物治疗，观察组在对照组的基础上予肺泡灌洗液感染病原NGS联合质谱分析方法检测患者病原学并指导抗生素的使用。比较两组生化指标及不良反应发生情况，绘制ROC曲线，分析肺泡灌洗液感染病原NGS联合质谱分析方法在免疫抑制合并重症肺炎患者中的治疗指导效能。 结果 两组治疗后酸碱度（pH）水平比较，差异无统计学意义（P>0.05）。观察组治疗后白细胞计数（WBC）、中性粒细胞水平低于对照组，动脉血氧分压（PaO2）、血氧饱和度（SaO2）水平高于对照组，差异有统计学意义（P<0.05）。观察组患者不良反应总发生率低于对照组，差异有统计学意义（P<0.05）。ROC曲线分析结果显示，NGS联合质谱分析在免疫抑制合并重症肺炎患者中的治疗指导效能均高于单一NGS和质谱分析，差异有统计学意义（P<0.05）。 结论 基于肺泡灌洗液感染病原NGS联合质谱分析用于免疫抑制合并重症肺炎患者的治疗，能获得良好的治疗效果，降低并发症发生率，可指导临床治疗，值得推广应用。

[关键词] 肺泡灌洗液感染病原;高通量基因序列;质谱分析;免疫抑制合并重症肺炎;ROC曲线

[中图分类号] R563.1          [文献标识码] A          [文章编号] 1673-9701（2021）06-0038-04

Application of next generation sequencing in alveolar lavage fluid infection pathogen of patients with immunosuppression combined with pneumonia

ZHOU Jiaqi   MA Xiaolong

Department of Respiratory Medicine， the First Hospital of Jiaxing in Zhejiang Province， Jiaxing   314000， China

[Abstract] Objective To explore the application effect and ROC curve analysis of next generation sequencing （NGS） combined with mass spectrometry in alveolar lavage fluid infection pathogen of patients with immunosuppression combined with severe pneumonia. Methods Fifty patients with immunosuppression combined with severe pneumonia from January 2017 to December 2019 treated in our hospital were selected as research subjects and randomly divided into the control group（n=25） and the observation group （n=25）. Empirical broad-spectrum antibacterial drug therapy was given to the control group， and NGS combined with mass spectrometry of alveolar lavage fluid infection pathogen was given to the observation group on the basis of the control group to detect the pathogen and guide the use of antibiotics. The ROC curve was drew， the therapeutic guidance effectiveness of NGS combined with mass spectrometry in alveolar lavage fluid infection pathogen of patients with immunosuppression combined with severe pneumonia was analyzed， and the curative effect and the adverse reaction were compared in the two groups. Results It was found that there was no statistically significant difference in pH after treatment between the two groups（P>0.05）. The white blood cell count （WBC） and neutrophils after treatment in the observation group were statistically significant lower than those in the control group， the partial arterial oxygen pressure（PaO2） and the blood oxygen saturation（SaO2） after treatment in the observation group were statistically significant higher than those in the control group （P<0.05）. The incidence rates during the treatment in the observation group was statistically significant lower than that in the control group（P<0.05）. ROC curve result showed that the guidance effectiveness of NGS combined with mass spectrometry in patients with immunosuppression combined with severe pneumonia was statistically significant higher than that of single NGS and mass spectrometry （P<0.05）. Conclusion The application of NGS combined with mass spectrometry in alveolar lavage fluid infection pathogen of patients with immunosuppression combined with pneumonia has good curative effect， and can reduce the incidence of complications and guide the clinic treatment， which is worthy of popularization and application.

[Key words] Alveolar lavage fluid infection pathogen; Next generation sequencing; Mass spectrometry; Immunosuppression combined with pneumonia; ROC curve

肺炎的严重程度取决于局部炎症程度、肺部炎症的播散及全身炎症反应程度，肺炎患者如出现较为严重的低氧血症或呼吸衰竭需要通气支持，或出现低血压、休克等循环衰竭表现，或出现其他器官功能障碍，均可判定为重症肺炎[1]。对于免疫抑制合并重症肺炎患者，由于其自身免疫调节异常，容易造成广泛组织损伤，再加上患者治疗时需要长期应用糖皮质激素或其他免疫抑制剂，导致其细胞体液免疫受到抑制，造成机体抵抗力降低，容易增加感染发生率[2-3]。近年……