超声引导下支气管内活检和宏基因组测序联合应用于非溶解性或缓慢溶解性肺炎的病因学诊断。

IF 2.1 4区 医学 Q3 RESPIRATORY SYSTEM
Canadian respiratory journal Pub Date : 2025-08-28 eCollection Date: 2025-01-01 DOI:10.1155/carj/7651699
Qiang Li, Li Jian, Qiquan Zhao
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引用次数: 0

摘要

背景:非溶解性或缓慢溶解性肺炎(NRP)给诊断带来了挑战,因为感染性和非感染性病因在影像学上经常模仿社区获得性肺炎。支气管超声引导下的经支气管肺活检(EBUS-TBLB)改善了周围病变的组织采集,而宏基因组新一代测序(mNGS)提供了与培养无关的病原体检测。它们的结合是否能提高NRP的病因澄清仍不确定。方法:109例连续对标准抗菌药物治疗无反应的NRP成人随机分为单独EBUS-TBLB组(n = 66)和EBUS-TBLB + mNGS组(n = 43)。记录基线特征、诊断率和手术相关并发症。使用χ 2或Fisher精确检验比较诊断阳性、感染因子敏感性和安全性,p < 0.05认为显著。结果:EBUS-TBLB联合方法的总诊断率从50.0%提高到72.1% (χ 2 = 4.37, p < 0.05)。mNGS显著提高了细菌性/真菌性肺炎(0%比13.9%,p < 0.05)和肺结核(0%比20.9%,p < 0.05)的检出率。恶性肿瘤仍是主要诊断(占所有病例的57.8%);大多数肿瘤亚型的产率在两组之间具有可比性。两组患者的并发症发生率无差异:轻度出血(19.7% vs. 23.3%)、缺氧(50.0% vs. 48.8%)、气胸(4.5% vs. 0%)和延迟恢复(4.5% vs. 7.0%) (p < 0.05)。未发生严重不良事件。结论:EBUS-TBLB + mNGS代表了复杂呼吸道病例诊断的范式转变,将成像与先进的基因组学相结合,以增强精准医学。在实践中,在NRP患者中早期实施EBUS-TBLB + mNGS诊断方案可以帮助排除恶性肿瘤或确认感染性病因。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Improved Etiological Diagnosis of Nonresolving or Slowly Resolving Pneumonia Through Combined Endobronchial Ultrasound-Guided Biopsy and Metagenomic Sequencing.

Improved Etiological Diagnosis of Nonresolving or Slowly Resolving Pneumonia Through Combined Endobronchial Ultrasound-Guided Biopsy and Metagenomic Sequencing.

Improved Etiological Diagnosis of Nonresolving or Slowly Resolving Pneumonia Through Combined Endobronchial Ultrasound-Guided Biopsy and Metagenomic Sequencing.

Background: Nonresolving or slowly resolving pneumonia (NRP) poses a diagnostic challenge because infectious and noninfectious etiologies often mimic community-acquired pneumonia on imaging. Endobronchial ultrasound-guided transbronchial lung biopsy (EBUS-TBLB) improves tissue acquisition for peripheral lesions, whereas metagenomic next-generation sequencing (mNGS) offers culture-independent pathogen detection. Whether their combination enhances etiological clarification of NRP remains uncertain. Methods: A total of 109 consecutive adults with NRP unresponsive to standard antimicrobial therapy were randomized to EBUS-TBLB alone (n = 66) or EBUS-TBLB + mNGS (n = 43). Baseline characteristics, diagnostic yield, and procedure-related complications were recorded. Diagnostic positivity, sensitivity for infectious agents, and safety profiles were compared using χ 2 or Fisher's exact tests, with p < 0.05 considered significant. Results: Overall diagnostic yield increased from 50.0% with EBUS-TBLB to 72.1% with the combined approach (χ 2 = 4.37, p < 0.05). mNGS significantly improved detection of bacterial/fungal pneumonia (0% vs. 13.9%; p < 0.05) and pulmonary tuberculosis (0% vs. 20.9%; p < 0.05). Malignancy remained the predominant diagnosis (57.8% of all cases); yields for most tumor subtypes were comparable between groups. Complication rates did not differ between the two groups: minor bleeding (19.7% vs. 23.3%), hypoxia (50.0% vs. 48.8%), pneumothorax (4.5% vs. 0%), and delayed recovery (4.5% vs. 7.0%) (p > 0.05). No severe adverse events occurred. Conclusions: EBUS-TBLB + mNGS represents a paradigm shift in the diagnosis of complex respiratory cases, integrating imaging with advanced genomics to enhance precision medicine. In practice, early implementation of the EBUS-TBLB + mNGS diagnostic protocol in patients with NRP can help exclude malignancy or confirm an infectious etiology.

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来源期刊
Canadian respiratory journal
Canadian respiratory journal 医学-呼吸系统
CiteScore
4.20
自引率
0.00%
发文量
61
审稿时长
6-12 weeks
期刊介绍: Canadian Respiratory Journal is a peer-reviewed, Open Access journal that aims to provide a multidisciplinary forum for research in all areas of respiratory medicine. The journal publishes original research articles, review articles, and clinical studies related to asthma, allergy, COPD, non-invasive ventilation, therapeutic intervention, lung cancer, airway and lung infections, as well as any other respiratory diseases.
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