Article(id=1261728980185526710, tenantId=1146029695717560320, journalId=1146119944283992078, issueId=1261728796072358112, articleNumber=null, orderNo=null, doi=null, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1778749230666, onlineDateStr=2026-05-14, pubDate=1774195200000, pubDateStr=2026-03-23, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1778749230666, onlineIssueDateStr=2026-05-14, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1778749230666, creator=13701087609, updateTime=1778749230666, updator=13701087609, issue=Issue{id=1261728796072358112, tenantId=1146029695717560320, journalId=1146119944283992078, year='2026', volume='4', issue='6', pageStart='1', pageEnd='234', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=1, specialIssue=null, createTime=1778749186771, creator=13701087609, updateTime=1778750183088, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1261732975067148479, tenantId=1146029695717560320, journalId=1146119944283992078, issueId=1261728796072358112, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1261732975071342784, tenantId=1146029695717560320, journalId=1146119944283992078, issueId=1261728796072358112, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=204, endPage=208, ext={CN=ArticleExt(id=1261728980881781177, articleId=1261728980185526710, tenantId=1146029695717560320, journalId=1146119944283992078, language=CN, title=下呼吸道感染患者咽拭子与肺泡灌洗液病原谱的病原靶向二代测序对比研究, columnId=1261728976733594600, journalTitle=实验室检测, columnName=分析与检测, runingTitle=null, highlight=null, articleAbstract=
目的 应用病原靶向二代测序（targeted next-generation sequencing, tNGS）技术，解析下呼吸道感染（lower respiratory tract infections, LRIs）患者咽拭子与肺泡灌洗液（bronchoalveolar lavage fluid, BALF）的病原谱特征，并阐明其检测效能差异。
方法 采用回顾性队列研究设计，纳入2022年4月—2025年9月同期送检咽拭子和BALF的1000例LRIs患者，应用tNGS技术对两类样本进行病原体检测，其中咽拭子采用上呼吸道检测通道（107种病原体），BALF采用下呼吸道检测通道（225种病原体）。研究队列划分为儿童组与成人组，重点分析这两类样本病原谱的构成差异。
结果 咽拭子与BALF的阳性检出率分别为97.4%、99.0%。儿童组（n=843）中，咽拭子对流感嗜血杆菌（42.2% vs 28.4%，P<0.001）、肺炎链球菌（31.7% vs 28.7%，P=0.040）及鲍曼不动杆菌（30.5% vs 2.3%，P<0.001）的检出率显著比BALF高，而BALF则更易检测到鼻病毒（31.2% vs 27.1%，P=0.006）、人呼吸道合胞病毒（20.9% vs 17.8%，P=0.006）、流感病毒（9.6% vs 7.0%，P=0.002）、人副流感病毒（15.3% vs 13.3%，P=0.019）、偏肺病毒（8.1% vs 6.1%，P=0.005）等RNA病毒，以及肺炎支原体（38.6% vs 28.6%，P<0.001）。成人组（n=157）中，咽峡炎链球菌群在咽拭子中的检出率高达82.2%（vs BALF 28.0%，P<0.001），而BALF对铜绿假单胞菌（8.9% vs 3.8%，P=0.039）和巨细胞病毒（14.7% vs 2.6%，P<0.001）的检测更具优势。耐药基因分析显示，23S rRNA A2063G突变位点在儿童BALF中检出率达24.1%，虽高于咽拭子（19.0%）但未达统计学差异（P>0.05）。此外，tNGS的下呼吸道检测通道在BALF中还额外检出结核分枝杆菌复合群、耶氏肺孢子菌、烟曲霉等31种深部病原体或下呼吸道特异性病原体。
结论 BALF在反映下呼吸道真实病原谱方面优于咽拭子，尤其对深部感染病原体检测价值显著，但咽拭子仍然是快速筛查的优先选择。儿童与成人的病原谱差异明显，提示结果解读需结合年龄因素。tNGS具高灵敏度与广谱优势，但仍需关注定植与条件致病菌的判读。
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