作者：温雅，杜焰家，黄娟，曾汉华，钟子双，张伟强

单位：

广东省梅州市人民医院呼吸与危重症医学科

Units：

Department of Pulmonary and Critical Care Medicine, Meizhou People’s Hospital;

关键词：

慢性阻塞性肺疾病; 下呼吸道感染; 环介导等温扩增技术; 诊断;

Keywords：

Chronic obstructive pulmonary disease;Lower respiratory tract infection;Loop mediated isothermal amplification;Diagnosis;

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.296

Funds：

广东省医学科学技术研究基金项目（B2021378）； 梅州市人民医院科研培育项目（PY-C2020026）；

摘要：

目的 探讨环介导等温扩增技术（LAMP）对慢性阻塞性肺疾病急性加重（AECOPD）伴下呼吸道感染的诊断价值。方法 选取2020—2021年在梅州市人民医院住院的AECOPD伴下呼吸道感染患者500例。入院后留取患者痰液或支气管肺泡灌洗液（BALF），同时采用LAMP和病原菌培养方法进行检测。共500份标本采用LAMP方法检测，530份标本采用病原菌培养方法进行检测。结果 LAMP检测结果显示，痰液中病原菌检出率高于BALF(P<0.05)。其中行机械通气者耐甲氧西林金黄色葡萄球菌、大肠埃希菌检出率及单一感染发生率高于未行机械通气者，结核分枝杆菌复合群检出率低于未行机械通气者（P<0.05）。LAMP的病原菌检出率高于病原菌培养方法（P<0.001）。其中LAMP对肺炎链球菌、耐甲氧西林金黄色葡萄球菌、流感嗜血杆菌、单一感染、混合感染检出率高于病原菌培养方法（P<0.05）。LAMP与病原菌培养方法检测铜绿假单胞菌结果的Kappa值为0.708，检测金黄色葡萄球菌结果的Kappa值为0.611，检测嗜麦芽窄食单胞菌结果的Kappa值为0.421。结论 与病原菌培养方法相比，LAMP对AECOPD伴下呼吸道感染患者的病原菌检出率更高，尤其是肺炎链球菌、耐甲氧西林金黄色葡萄球菌、流感嗜血杆菌等苛养菌或条件致病菌；且采用LAMP检测AECOPD伴下呼吸道感染患者时，其痰液中病原菌检出率高于BALF。

Abstract：

Objective To explore the diagnostic value of loop mediated isothermal amplification（LAMP） for acute exacerbation of chronic obstructive pulmonary disease（AECOPD） with lower respiratory tract infection. Methods A total of 500 AECOPD patients with lower respiratory tract infection hospitalized in Meizhou People’s Hospital from 2020 to 2021 were selected. After admission, sputum or bronchoalveolar lavage fluid（BALF） was collected and tested by LAMP and pathogen culture. A total of 500 specimens were detected by LAMP, and 530 specimens were detected by pathogen culture. Results LAMP results showed that the detection rate of pathogenic bacteria in sputum was higher than that in BALF（P < 0.05）. The detection rates of methicillin resistant Staphylococcus aureus and escherichia coli, and single infection rate in patients with mechanical ventilation were higher than those in patients without mechanical ventilation, and the detection rate of mycobacterium tuberculosis complex was lower than that in patients without mechanical ventilation（P < 0.05）. The detection rate of pathogenic bacteria of LAMP was higher than that of pathogen culture（P < 0.001）. The detection rate of LAMP for Streptococcus pneumoniae, methicillinresistant Staphylococcus aureus, Haemophilus influenzae, single infection and mixed infection was higher than that of pathogen culture（P < 0.05）. The Kappa value of LAMP and pathogen culture method for detecting Pseudomonas aeruginosa was 0.708, the Kappa value of LAMP and pathogen culture method for detecting Staphylococcus aureus was 0.611, and the Kappa value of LAMP and pathogen culture method for detecting Stenotrophomonas maltophilia was 0.421. Conclusion Compared with the pathogen culture, LAMP has a higher detection rate of pathogenic bacteria in patients with AECOPD and lower respiratory tract infection, especially Streptococcus pneumoniae, methicillin-resistant Staphylococcus aureus, Haemophilus influenzae and other fastidious or conditional pathogenic bacteria. The detection rate of pathogenic bacteria in sputum is higher than that in BALF when LAMP was used to detect AECOPD patients with lower respiratory tract infection.

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