肺泡灌洗液tNGS病原谱的年龄分布及其临床意义

Age-stratified characteristics of tNGS-detected pathogen spectrum in bronchoalveolar lavage fluid and their clinical significance

    摘要
  • 摘要:
    目的 探讨基于靶向二代测序（tNGS）的肺泡灌洗液（BALF）病原谱的年龄分层与混合感染特征，以期为临床解读tNGS报告、制定年龄导向的精准抗感染策略提供参考。
    方法 回顾性分析2024年9－12月河南省多家医院送检、经筛选后的799例BALF tNGS检测结果。按患者年龄分为≤18岁组（49例）、＞18～40岁组（77例）、＞40～65岁组（315例）、＞65～80岁组（288例）和＞80岁组（70例）。分析总体病原谱与混合感染特征，并比较不同年龄组病原体分布差异。
    结果 799例样本中，阳性739例（92.49%），其中混合感染494例（66.85%），单一感染245例（33.15%）。共检出病原体107种、1 856株，构成比居前3位的分别为肺炎克雷伯菌（8.51%）、白色念珠菌（6.52%）及铜绿假单胞菌（5.33%）。病原体以革兰阴性菌为主（32.92%），其次为病毒（23.55%）和真菌（20.58%）。在混合感染样本中，白色念珠菌、鲍曼不动杆菌和肺炎克雷伯菌的共感染率位居前三（分别为96.69%、96.15%、87.97%）。年龄分层分析显示，各年龄组在感染病原体种类数、单一感染率及多重感染率方面差异均有统计学意义（均P＜0.001）。≤18岁组的特色病原体为肺炎支原体、流感嗜血杆菌及金黄色葡萄球菌（RR值分别为9.39、2.19、3.67），＞80岁组则以肺炎克雷伯菌和纹带棒杆菌为主（RR值分别为1.68、4.58）。
    结论 tNGS有助于系统分析BALF中复杂病原谱与混合感染特征。病原体分布及共同感染模式具有显著的年龄特异性，研究结果可为临床解读tNGS报告、鉴别关键致病菌从而制定年龄导向的精准抗感染策略提供重要参考。

     

    Abstract:
    OBJECTIVE  To investigate the age stratification and mixed infection characteristics of the pathogen spectrum in bronchoalveolar lavage fluid （BALF） based on targeted next-generation sequencing （tNGS）, thereby providing references for clinical interpretation of tNGS reports and formulating precise age-tailored anti-infection strategies.
    METHODS  A retrospective analysis was performed on the tNGS results of 799 screened BALF samples collected from multiple hospitals in Henan Province between Sep. 2024 and Dec. 2024. The patients' data were stratified into five age groups: ≤18 years （n=49）, ＞18–40 years （n=77）, ＞40–65 years （n=315）, ＞65–80 years （n=288） and ＞80 years （n=70）. The overall pathogen spectrum and mixed infection characteristics were analyzed, and differences in pathogen distribution across age groups were compared.
    RESULTS  Among the 799 samples, 739 （92.49%） were positive, including 494 （66.85%） cases of mixed infection and 245 （33.15%） cases of single infection. A total of 107 pathogens and 1 856 strains were detected, with the top three being Klebsiella pneumoniae （8.51%）, Candida albicans （6.52%） and Pseudomonas aeruginosa （5.33%）. Additionally, gram-negative bacteria predominated （32.92%）, followed by viruses （23.55%） and fungi （20.58%）. In mixed infection samples, C. albicans, Acinetobacter baumannii and K. pneumoniae exhibited the highest mixed infection rates （96.69%, 96.15% and 87.97%, respectively）. Age-stratified analysis revealed statistically significant differences among groups in the number of pathogen types, single infection rates and mixed infection rates （all P＜0.001）. The ≤18 years group was characterized by Mycoplasma pneumoniae, Haemophilus influenzae and Staphylococcus aureus （RR=9.39, 2.19 and 3.67, respectively）, while the ＞80 years group was dominated by K. pneumoniae and Corynebacterium striatum （RR=1.68 and 4.58, respectively）.
    CONCLUSIONS  The tNGS facilitates systematic analysis of complex pathogen spectra and mixed infection patterns in BALF. The distribution of pathogens and mixed infection profiles exhibit significant age-specificity, providing significant insights for clinical interpretation of tNGS reports and the development of age-tailored precision anti-infection strategies.

     

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