在诊断严重呼吸道病毒感染方面,临床采样面临着挑战
Antonio Piralla1, Cristina Russo2, Stefania Ranno2
1Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Chest
|March 9, 2026
概括
下呼吸道 (LRT) 采样在严重急性呼吸道感染 (SARI) 患者中检测到更多的呼吸道病毒,而不是上呼吸道 (URT) 采样. 慢慢回路抽样可以提高诊断灵敏度,因此应考虑对SARI患者进行抽样.
科学领域:
- 医学诊断 医学诊断 医学诊断
- 病毒学 病毒学
- 呼吸系统药物 呼吸系统药物
背景情况:
- 呼吸道病毒导致严重的肺炎,特别是在严重急性呼吸道感染 (SARI) 病例中.
- 准确的SARI诊断严重依赖于适当的样本地点选择进行分子测试.
研究的目的:
- 为了比较SARI患者的上呼吸道 (URT) 和下呼吸道 (LRT) 样本之间的诊断产量和呼吸道病毒检测一致性.
- 评估采样地点对住院患者呼吸道病毒诊断准确性的影响.
主要方法:
- 一项多中心的回顾性研究分析了SARI患者 (2014-2022) 的配对URT和LRT样本.
- 多重PCR测定用于呼吸道病毒检测.
- 病毒检测率,一致性,不一致性和量化周期 (Cq) 值 (病毒负载代理) 在样本类型之间进行了比较.
主要成果:
- 在346个配对样本中,32.1%是不一致的,在21.7%的病例中,在LRT中检测到病毒,但在URT样本中没有病毒.
- 流感A病毒 (IAV),犀利病毒/肠病毒 (RV/EV) 和呼吸道同胞病毒 (RSV) 是最常见的.
- 在LRT样本中,中位数Cq值显著较低 (24.5比27.5),表明病毒载量较高,特别是在一致的对中.
结论:
- 仅依靠URT采样可能导致SARI患者错过病毒诊断.
- 慢性呼吸道病毒采样提高了对呼吸道病毒的诊断灵敏度,特别是在感染后期.
- 将LRT采样纳入诊断协议可以改善用于SARI管理的临床决策.
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