呼吸道病原菌核酸检测在HAP/VAP患者中的应用

丁伟超; 许铁; 燕宪亮; 叶英; 任泽强; 张蓬波; 吕建农

doi:10.13201/j.issn.1009-5918.2019.07.013

呼吸道病原菌核酸检测在HAP/VAP患者中的应用

- 1. 徐州医科大学附属医院急救中心徐州医科大学急救与救援医学系江苏省卫生应急研究所(江苏徐州, 221000);
- 2. 徐州医科大学附属医院胰腺外科

详细信息

通讯作者: 许铁,E-mail:xutie889@163.com

中图分类号: R563.1

收稿日期: 2018-10-17

Application of nucleic acid detection of pathogenic bacteria in respiratory tract for patients with hospital-acquired pneumonia or ventilator-associated pneumonia

- 1 Emergency Center, the Affiliated Hospital of Xuzhou Medical University, Department of Emergency and Rescue Medicine, the Xuzhou Medical University, Jiangsu Provincial Insritute of Health Emergency, Xuzhou, Jiangsu, 221000, China;
- 2 Department of Pancreatic surgery, the Affiliated Hospital of Xuzhou Medical University

More Information

Corresponding author: XU Tie, E-mail: xutie889@163.com

Received Date: 17 October 2018

摘要

摘要: 目的: 研究呼吸道病原菌核酸检测在HAP/VAP患者中的应用。方法: 回顾性分析我院急诊重症医学科2018-02—09期间收治的行呼吸道病原菌核酸检测的82例HAP/VAP患者,留取患者痰标本,送细菌培养+药敏的同时行呼吸道病原菌核酸检测。结果: McNemar检验显示,核酸检测与痰培养结果阳性率差异无统计学意义(P>0.05),核酸检测结果阳性率稍大于痰培养;κ检验显示,两种检测方法的吻合度一般,差异有统计学意义(κ=0.616、P<0.01)。核酸检测与痰培养结果基本一致,主要为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯杆菌、耐甲氧西林金黄色葡萄球菌等,部分核酸检测法和(或)痰培养结果为多种病原菌。对于鲍曼不动杆菌,McNemar显示两种检测方法阳性率比较,差异无统计学意义(P>0.05);κ检验显示两种检测方法的吻合度比较,差异有统计学意义(κ=0.817、P<0.01)。对于铜绿假单胞菌,McNemar显示两种检测方法阳性率比较,差异无统计学意义(P>0.05);κ检验显示两种检测方法的吻合度一般,差异有统计学意义(κ=0.585、P<0.01)。对于肺炎克雷伯杆菌,McNemar显示两种检测方法阳性率比较,差异无统计学意义(P>0.05);κ检验显示两种检测方法的吻合度一般,差异有统计学意义(κ=0.488、P<0.01)。对于耐甲氧西林金黄色葡萄球菌,McNemar显示两种检测方法阳性率差异有统计学意义(P<0.05);κ检验显示两种检测方法的吻合度差(κ=0.212、P<0.01)。结论: 呼吸道病原菌核酸检测与痰培养结果基本一致,且具有灵敏度高、检测迅速的优点,有助于抗生素的早期筛选,值得临床上推广应用。
- 呼吸道病原菌核酸检测 /
- 痰培养 /
- HAP/VAP
Abstract: Objective: To study the application of nucleic acid detection of pathogenic bacteria in respiratory tract for patients with hospital-acquired pneumonia or ventilator-associated pneumonia.Method: The clinical data of 82 patients with HAP/VAP in our hospital EICU from February 2018 to September 2018 were retrospectively analyzed.Sputum specimens of patients were collected,sputum bacterial culture and drug sensitivity detection were performed,at the same time,nucleic acid detection of pathogenic bacteria in respiratory tract was performed.Result: McNemar test showed that the difference was not statistically significant in the positive rate between nucleic acid detection and sputum culture(P>0.05),while the positive rate of nucleic acid detection was slightly higher than that of sputum culture.Kappa test showed that the two detection methods were generally consistent and had statistical significance(κ=0.616,P=0.000).Nucleic acid detection was basically consistent with the results of sputum culture,mainly including acinetobacter baumannii,pseudomonas aeruginosa,klebsiella pneumoniae MASA.Partial nucleic acid detection or/and sputum culture results were a variety of pathogenic bacteria.For acinetobacter baumannii,McNemar showed that the difference was not statistically significant in the positive rate between the two detection methods(P>0.05).Kappa test showed that the two methods were statistically significant and highly consistent(κ=0.817,P=0.000).For pseudomonas aeruginosa,McNemar showed that the difference was not statistically significant in the positive rate between the two methods(P>0.05).Kappa test showed that the two methods were generally consistent and statistically significant(κ=0.585,P=0.000).For klebsiella pneumoniae,McNemar showed that the difference was not statistically significant in the positive rate between the two methods(P>0.05).Kappa test showed that the two methods were generally consistent and statistically significant(κ=0.488,P=0.000).For methicillin resistant staphylococcus aureus,McNemar showedthat the difference was statistically significant in the positive rate between the two detection methods(P<0.05).Kappa test showed that the two methods were not identical(κ=0.212,P=0.002).Conclusion: The nucleic acid detection of pathogenic bacteria in respiratory tract is basically consistent with the results of sputum culture,and has the advantages of high sensitivity and rapid detection,which is helpful for early screening of antibiotics and worthy of clinical application.

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