非呼吸机相关医院获得性肺炎诊断流程的系统综述
该系统综述评估非呼吸机相关医院获得性肺炎（NV-HAP）现有诊断方法的有效性、可接受性与准确性。共筛选26780条记录，最终纳入8项研究，涉及血生物标志物、采样方法和分子诊断。因异质性大未能定量合成，结论认为现有诊断证据有限且不一致，亟需标准化诊断标准。
要点
- 血降钙素原经ROC分析提出切点，但证据仅来自2项研究。
- 支气管肺泡灌洗液采样性能优于咳痰和气管内吸引物。
- 分子诊断检出率更高且与传统培养一致性良好。
核心结论
- NV-HAP研究仍不充分，现有诊断证据有限且不一致。
- 亟需标准化、经过验证的诊断标准以提升研究可比性和临床诊断可靠性。
研究设计与样本
- 系统综述，方案注册号CRD42023375750。
- 检索PubMed、Cochrane Library、CINAHL、EMBASE、Web of Science及灰色文献。
- 筛选26780条记录，317篇全文审查，最终纳入8项研究。
- 采用改良CASP诊断研究清单评估纳入研究质量。
主要发现
- 2项研究评估血液生物标志物，经ROC分析提出降钙素原切点。
- 4项研究评估采样方法，支气管肺泡灌洗性能优于咳痰和气管内吸引物。
- 2项研究评估分子诊断，检出率更高且与传统培养方法一致性良好。
- 研究间异质性大，未能进行定量合成。
临床怎么用
- 现有证据支持下呼吸道标本中支气管肺泡灌洗液采样用于NV-HAP诊断。
- 分子诊断可作为提高病原检出率的手段，但需结合传统培养结果解读。
局限性
- 纳入研究仅8项，NV-HAP诊断领域研究不足。
- 研究间存在显著异质性，无法进行定量合成。
- 现有诊断证据有限且不一致，缺乏标准化诊断标准。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Int J Infect Dis. 2026 Aug;169:108764. doi: 10.1016/j.ijid.2026.108764. Epub 2026 May 8. ABSTRACT OBJECTIVES: Non-ventilator hospital-acquired pneumonia (NV-HAP) is an important hospital-acquired infection with high morbidity and mortality. This review aimed to evaluate the effectiveness, acceptability, and accuracy of current diagnostic procedures for NV-HAP. METHODS: The protocol was published in the International Prospective Register of Systematic Reviews under registration CRD42023375750. A comprehensive search of PubMed, The Cochrane Library, CINAHL, EMBASE, Web of Science, and grey literature was conducted using terms related to NV-HAP diagnostics. Eligible studies were appraised using a modified Critical Appraisal Skills Programme checklist for diagnostic studies. RESULTS: Of 26,780 records screened, 317 underwent full-text review and eight met inclusion criteria. Two studies evaluated biomarkers in blood and suggested cut-off points for procalcitonin after receiver operating characteristics analysis. Four studies evaluated sampling methods and showed a superior performance of bronchoalveolar lavage compared to expectorated sputum and endotracheal aspirates. Two studies evaluated molecular diagnostics, presenting higher detection rates and good agreement with conventional culturing methods. Substantial heterogeneity prevented quantitative synthesis. CONCLUSION: NV-HAP remains insufficiently investigated, and available diagnostic evidence is limited and inconsistent. Standardized, validated diagnostic criteria are urgently needed to strengthen future research, enable comparability across studies, and improve diagnostic reliability in clinical practice. PMID: 42107873 | DOI: 10.1016/j.ijid.2026.108764
引用
- PubMed 高证据 · 肺炎：Non-ventilator hospital-acquired pneumonia diagnostic procedures: A systematic review
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。