环介导恒温扩增芯片法在下呼吸道感染病原体检测中的临床应用

目的分析环介导恒温扩增芯片法(LAMP)在下呼吸道感染病原体检测中的应用价值。 方法选择2018年1月至2018年9月空军军医大学第二附属医院收治的1 092例疑似下呼吸道感染患者，分析支气管肺泡灌洗液病原体检测结果，以细菌培养结果为金标准，评价LAMP检测8种常见下呼吸道感染病原体的灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比。 结果LAMP检测8种病原体的灵敏度差异较大，检测金黄色葡萄球菌灵敏度最高(100%)，检测大肠埃希菌灵敏度最低(40%)，检测8种病原体的特异度均高于94%。LAMP检测8种病原体的阳性预测值低于65%，阴性预测值高于98%，阳性似然比高于13，阴性似然比各病原体间差异较大，金黄色葡萄球菌阴性似然比最低(0.00)，大肠埃希菌阴性似然比最高(0.60)。 结论LAMP在下呼吸道感染病原体检测中有较高的准确性，利于下呼吸道感染的早期诊断和精准治疗，具有临床意义。

Clinical application the loop-mediated isothermal amplification assay for the identification of pathogens in lower respiratory tract infections

ObjectiveTo more accurately evaluate the performance of loop-mediated isothermal amplification (LAMP) assay for the identification of pathogens in lower respiratory tract infections(LRTIs). MethodsThe pathogen identification results of 1092 bronchoalveolar lavage fluid (BALF) samples from presumptive LRTI patients admitted to the Tangdu Hospital from January 2018 to September 2018 were analyzed retrospectively. Taking the bacterial culture as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of LAMP for detecting 8 common lower respiratory tract infection pathogens were calculated. ResultsThe sensitivity of LAMP for detecting 8 pathogens were quite different, with the highest sensitivity to Staphylococcus aureus (100%) and the lowest sensitivity to Escherichia coli (40%). The specificity of LAMP for detecting 8 pathogens were higher than 94%. The positive predictive value of the LAMP test results for 8 pathogens were lower than 65%, the negative predictive value were higher than 98%, the positive likelihood were higher than 13. The negative likelihood ratio of the LAMP test results for 8 pathogens were quite different, with the lowest negative likelihood ratio to Staphylococcus aureus (0.00) and the highest negative likelihood ratio to Escherichia coli (0.60). ConclusionThe LAMP has high accuracy in detecting pathogens of lower respiratory tract infections, which is helpful for early diagnosis and precise treatment of lower respiratory tract infections.