【摘要】 目的 研究基于多重病原体PCR的靶向基因组测序技术辅助诊断恶性肿瘤患者下呼吸道感染的可行性。方法 应用基于多重病原体PCR的靶向基因组测序(tNGS)和临床常规微生物培养(培养法)分别检测疑似呼吸道感染的恶性肿瘤患者的痰液或肺泡灌洗液，比较tNGS和培养法病原体鉴定结果及其与患者临床诊疗的符合度。结果 在198例患者中，tNGS和培养法检测均阳性45例(22.7%),均阴性62例(31.3%),tNGS阴性但培养法阳性5例(2.5%),而tNGS阳性但培养法阴性86例(43.4%),tNGS阳性病例中有24例指导临床更换抗菌药物，35例指导临床更换抗病毒治疗，并取得了明显的治疗效果。tNGS和培养法的总检出率分别为66.2%和25.2%,差异具有统计学意义(P<0.05);tNGS病原体的检出率明显高于培养法。tNGS对细菌、病毒、结核分枝杆菌、真菌及支原体的检出率分别为53.6%、89.4%、2.4%、46.9%和0.48%,均显著高于培养法(细菌及真菌检出率为11.1%和3.19%,其余病原体未检出)。此外，tNGS与患者临床诊疗的符合度为97.5%,明显高于培养法的56.6%(P<0.05)。结论 基于多重病原体PCR的靶向基因组测序(tNGS)技术在恶性肿瘤患者下呼吸道感染的病原体鉴定中具有显著优势。tNGS技术在病原体鉴定方面具有更广泛的覆盖范围和更短的报告时间，但其结果仍需临床医师的仔细分析和解读。建议在临床实践中将tNGS与传统培养法结合使用，以提高下呼吸道感染的诊断准确性和治疗效果。更多还原

【Abstract】 Objective To study the feasibility of multi-pathogen PCR-based targeted genome sequencing in the diagnosis of lower respiratory tract infection in patients with malignant tumors.Methods Multi-pathogen PCR based targeted genome sequencing(tNGS) and clinical routine microbial culture(culture method) were used to detect sputum or alveolar lavage fluid of malignant tumor patients suspected of respiratory tract infection, and the pathogen identification results and their clinical consistency of tNGS and culture method were compared.Results Among the 198 patients, 45 cases(22.7%) were positive for tNGS and culture method, 62 cases(31.3%) were negative, 5 cases(2.5%) were negative for tNGS,but culture method were positive, and 86 cases(43.4%) were positive for tNGS,but culture method were negative, of which 24 cases were instructed to change antibiotics clinically.35 patients were instructed to change antiviral therapy.The total detection rates of tNGS and culture method were 66.2% and 25.2%,respectively, and the difference was statistically significant(P<0.05).The detection rate of tNGS pathogen was significantly higher than that of culture method.The detection rates of tNGS for bacteria, viruses, mycobacterium tuberculosis, fungi and mycoplasma were 53.6%,89.4%,2.4%,46.9% and 0.48%,respectively, which were significantly higher than that of culture method(the detection rates of bacteria and fungi were 11.1% and 3.19%,and other pathogens were not detected).In addition, the clinical conformity of tNGS was 97.5%,which was significantly higher than that of culture method(56.6%)(P<0.05).Conclusion Multi-pathogen PCR-based targeted genome sequencing(tNGS) has significant advantages in pathogen identification of lower respiratory tract infections in patients with malignant tumors.tNGS technology has a wider coverage and shorter reporting time for pathogen identification, but its results still require careful analysis and interpretation by clinicians.It is suggested that tNGS should be combined with traditional culture in clinical practice to improve the diagnostic accuracy and treatment effect of lower respiratory tract infection.更多还原