tNGS技术在天津市发热呼吸道症候群病原特征分析的应用研究

doi:10.20223/j.cnki.1000-8535.2024.12.006

摘要/Abstract

摘要： 目的利用靶向二代测序技术探究天津市发热呼吸道症候群病原特征,分析病原流行特征,总结规律,为发热伴呼吸道症候群患者治疗策略提供指导。方法收集2023年1月—2023年12月天津地区某四家医院初诊为发热伴呼吸道症候群的4 039例病例,通过tNGS技术检测,分析鉴定病原微生物,研究不同标本类型病原微生物分布、年龄分布、性别分布、不同时间季节感染分布、微生物类型分布趋势等。结果 4 039例经tNGS技术检测,共检测出90种潜在病原体,总阳性率为94.80%（3 829/4 039）。包括36种细菌、29种病毒、5种非典型病原体和20种真菌。不同种类病原体检出频次排序：革兰阴性细菌（G-细菌）>RNA病毒>DNA病毒>革兰阳性细菌（G+细菌）>真菌>非典型病原体。男女性别阳性检出率比较差异无统计学意义（χ²=0.249,P=0.618）;不同年龄段人群病原体谱有异质性,且阳性患者多分布在0~10岁和>60岁,阳性也集中在该两类人群,阳性率分别为47.90%（1 834/3 829）和31.24%（1 196/3 829）。在单一感染中,肺炎支原体占比最高,为4.91%,其次为新型冠状病毒,占1.59%,再次为呼吸道合胞病毒,占1.23%。不同季节不同感染类型具有差异,整体呈现夏冬季混合感染率高的特点,即夏季新冠病毒合并细菌（鲍曼不动杆菌、肺炎链球菌）,冬季肺炎支原体合并甲型、乙型流感病毒多见。肺炎支原体对大环内酯类药物耐药率随月份呈现增加趋势。结论 tNGS 技术在天津市发热呼吸道症候群样本中获得了较高的病原体检出率,病原体覆盖面广,通过提供更多的病原体信息,可以有效辅助鉴别混合感染和耐药信息。

关键词: 靶向二代测序, 发热呼吸道症候群, 病原体, 特征分析

Abstract: Objective Using targeted next-generation sequencing technology to explore the composition of the pathogenic spectrum of febrile respiratory syndrome ,analyze the epidemic characteristics of the pathogen,summarize the rules,and provide accurate guidance for the treatment strategy of patients with febrile respiratory syndrome．Methods By tNGS detection of 4039 cases with fever with respiratory diseases in four hospitals in Tianjin in 2023,pathogenic microorganisms were analyzed and identified,and the distribution of pathogenic microorganisms,age distribution,gender distribution,infection distribution in different times and seasons,and distribution trend of microbial types in different specimen types were studied．Results In 4039 cases,90 potential pathogens were detected,the total positive rate was 94.80%（3 829/4 039）,including 36 kinds of bacteria,29 kinds of viruses,5 kinds of atypical pathogen and 6 kinds of fungi．The order of detection frequency of different types of pathogens：G-bacteria > RNA virus > DNA virus > G+ bacteria > fungi > atypical pathogens．There was no significant difference in the positive rate of male and female between the two groups（χ²=0.249,P=0.618）．The pathogen spectrum of different age groups was heterogeneous． The positive patients were mostly distributed in 0-10 years old [47.90%（1 834/3 829）] and >60 years old [31.23%（1 196/3 829）]．Among the single infection,Mycoplasma pneumoniae accounted for the highest proportion,4.91%（188/3829）,followed by 2019-nCoV,1.59%（61/3 829）,and respiratory syncytial virus,1.23%（47/3 829）．There were differences in different infection types in different seasons,and the overall characteristics of mixed infection rate in summer and winter were high． In summer,the new coronavirus was combined with bacteria（Acinetobacter baumannii,Streptococcus pneumoniae）,and in winter,Mycoplasma pneumoniae was combined with influenza A and B viruses．The resistance rate of Mycoplasma pneumoniae to macrolides showed an increasing trend with the time．Conclusions The tNGS technology had obtained a high pathogen detection rate in the samples of febrile respiratory syndrome in Tianjin．By providing more pathogen information,it can be effectively applied to the etiological diagnosis of respiratory infectious diseases and assist in the identification of mixed infections and drug resistance information．

Key words: targeted next-generation sequencing, fever respiratory syndrome, pathogen, characteristic analysis

张静, 张厚亮, 周兴悦, 刘春莉, 蔡远扬, 张萌, 田春锁. tNGS技术在天津市发热呼吸道症候群病原特征分析的应用研究[J]. 广州医药, 2024, 55(12): 1421-1429.

ZHANG Jing, ZHANG Houliang, ZHOU Xingyue, LIU Chunli, CAI Yuanyang, ZHANG Meng, TIAN Chunsuo. Application of pathogenic characteristics of febrile respiratory syndrome in Tianjin based on tNGS technology[J]. Guangzhou Medical Journal, 2024, 55(12): 1421-1429.

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