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山东大学学报 (医学版) ›› 2025, Vol. 63 ›› Issue (11): 36-45.doi: 10.6040/j.issn.1671-7554.0.2025.0344

• 临床医学 • 上一篇    

BALF tNGS检测及培养对NSCLC合并IPFD的诊断价值

刘振昆1,吕纪玲2,徐伟伟3,马力天4,5,6,张才擎1,2   

  1. 1.山东大学齐鲁医学院, 山东 济南 250012;2.山东省第二人民医院呼吸与危重症医学科, 山东 济南 250022;3.山东省第二人民医院儿科, 山东 济南 250022;4.空军军医大学唐都医院胸腔外科, 陕西 西安 710038;5.空军军医大学唐都医院中西医结合肿瘤专科, 陕西 西安 710038;6.陕西省中西医结合肿瘤诊疗重点实验室, 陕西 西安 710038
  • 发布日期:2025-11-28
  • 通讯作者: 张才擎. E-mail:freezcq@163.com
  • 基金资助:
    山东省第二人民医院院级科研基金项目(2023GCC04);山东大学横向课题(6020219018)

Value of tNGS testing and conventional culture for BALF in the diagnosis of NSCLC complicated with IPFD

LIU Zhenkun1, LYU Jiling2, XU Weiwei3, MA Litian4,5,6, ZHANG Caiqing1,2   

  1. 1. Qilu Medical College of Shandong University, Jinan 250012, Shandong, China;
    2. Department of Respiratory and Critical Care Medicine, Shandong Second Provincial General Hospital, Jinan 250022, Shandong, China;
    3. Department of Pediatrics, Shandong Second Provincial General Hospital, Jian 250022, Shandong, China;
    4. Department of Thoracic Surgery, Tangdu Hospital, Air Force Military Medical University, Xian 710038, Shaanxi, China;
    5. Department of Integrated Traditional Chinese and Western Medicine Oncology, Tangdu Hospital, Air Force Military Medical University, Xian 710038, Shaanxi, China;
    6. Shaanxi Key Laboratory of Integrated Traditional Chinese and Western Medicine for Tumor Diagnosis and Treatment, Xian 710038, Shaanxi, China
  • Published:2025-11-28

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摘要： 目的 探究支气管肺泡灌洗液(bronchoalveolar lavage fluid, BALF)病原微生物靶向测序(targeted next generation sequencing, tNGS)技术与传统培养在非小细胞肺癌(non-small cell lung cancer, NSCLC)合并侵袭性肺真菌病(invasive pulmonary fungal disease, IPFD)中的诊断价值。 方法 回顾性分析2022年9月1日至2025年4月1日40例于山东省第二人民医院临床诊断为NSCLC合并IPFD患者的临床资料,收集BALF样本行tNGS检测与传统培养,对比分析病原检出率及诊断效能。 结果 40例IPFD患者样本中,tNGS和传统培养对真菌的阳性检出率分别为85.0%、52.5%(校正χ2 = 6.86,P=0.01),对细菌的阳性检出率分别为70.0%、50.0%(校正χ2=4.08,P=0.04)。tNGS和传统培养对细菌的检测灵敏度分别为95.5%、86.4%(校正χ2=0.25,P=0.62)。所有患者经抗真菌、细菌及抗肿瘤治疗后均好转出院。 结论 tNGS技术在NSCLC合并IPFD的病原检测中,对真菌和细菌的检测效能均显著优于BALF传统培养。临床上可将tNGS作为早期筛查工具,结合BALF培养、临床特征综合判读,以优化诊疗并避免过度治疗。

关键词: 非小细胞肺癌, 侵袭性肺真菌病, 肺泡灌洗液, 病原微生物靶向测序, 诊断价值

Abstract: Objective To investigate the diagnostic value of targeted next-generation sequencing(tNGS)for pathogens in bronchoalveolar lavage fluid(BALF)compared with traditional culture in non-small cell lung cancer(NSCLC)complicated with invasive pulmonary fungal disease(IPFD). Methods A retrospective analysis was conducted on the clinical data of 40 patients clinically diagnosed with NSCLC complicated with IPFD at Shandong Second Provincial General Hospital from September 1, 2022, to April 1, 2025. BALF samples were collected for tNGS detection and traditional culture, and the pathogen detection rates and diagnostic efficacy were compared and analyzed. Results Among the 40 IPFD patient samples, the positive detection rates for fungi by tNGS and traditional culture were 85.0% and 52.5%, respectively(corrected χ2=6.86, P=0.01), and for bacteria, they were 70.0% and 50.0%, respectively(corrected χ2=4.08, P=0.04). The detection sensitivities for bacteria by tNGS and traditional culture were 95.5% and 86.4%, respectively(corrected χ2=0.25, P=0.62). All patients improved and were discharged after antifungal, antibacterial, and antitumor treatments. Conclusion tNGS technology demonstrates significantly superior detection efficacy for both fungi and bacteria in pathogen detection for NSCLC complicated with IPFD compared to traditional BALF culture. Clinically, tNGS can be used as an early screening tool, and combined with BALF culture and clinical features for comprehensive interpretation, to optimize diagnosis and treatment and avoid overtreatment.

Key words: Non-small cell lung cancer, Invasive pulmonary fungal disease, Bronchoalveolar lavage fluid, Targeted next-generation sequencing, Diagnostic value

中图分类号: 

  • R735.6
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