目的 通过对比分析晚期非小细胞肺癌（NSCLC）患者支气管肺泡灌洗液（BALF）外泌体、血液和肺癌组织3种标本表皮生长因子受体（EGFR）基因突变情况，评估支气管肺泡灌洗液外泌体标本是否适合应用于临床靶向治疗前的患者筛检，为晚期NSCLC患者尽早个体化治疗提供新的思路和筛检方法。 方法 回顾性分析2021年5月至2023年5月贵州航天医院呼吸与危重症医学科78例晚期NSCLC患者利用扩增阻滞突变系统法（ARMS）检测支气管泡灌洗液外泌体、血液、肺癌组织标本EGFR基因突变的结果并以肺癌组织标本结果为标准进行相互比较。 结果 支气管肺泡灌洗液外泌体、血液、肺癌组织标本分别检出EGFR突变型33、25、38例，EGFR基因野生型分别42、53、40例，检测突变率分别为42.3%（33/78）、32.1%（25/78）、48.7%（38/78）。支气管肺泡灌洗液检测无结果3例，假阴性率6.4%（5/78），血液检测假阴性率16.7%（13/78）。支气管肺泡灌洗液外泌体标本EGFR基因突变的检测符合率86.8%（33/38），血液标本检测符合率65.8%（25/38）。 结论 支气管肺泡灌洗液外泌体标本检测EGFR基因突变与血液、肺癌组织标本检测具有一致性（P > 0.05），优于血液标本，适用于临床靶向治疗前的患者筛选，为晚期NSCLC患者尽早个体化治疗决策提供了新的思路和筛检方法。

Objective To compare and analyze the gene mutation of EGFR of bronchoalveolar lavage fluid （BALF） exosome， serum and lung cancer tissue specimens of patients with advanced non?small cell lung cancer （NSCLC） and assess whether the BALF exosome specimens are suitable for screening before clinical targeted therapy， to provide new ideas and screening methods for early individualized treatment of advanced NSCLC patients. Methods BALF exosomes， serum and lung cancer tissue specimens EGFR gene mutations of 78 cases with advanced NSCLC were detected by using amplification refractory mutation system（ARMS） method in Department of Respiratory and Critical Care Medicine in our hospital from May 2021 to May 2023， and the results were retrospectively analyzed. A comparative analysis of the specimens was conducted using lung cancer tissue specimens as benchmarks. Results A total of 33， 25 and 38 cases of EGFR gene mutation and 42， 53 and 40 cases of EGFR wild type were detected in BALF exosomes， serum and lung cancer tissues specimens respectively. The mutation rate of EGFR gene was 42.3%（33/78， 32.1 %（25/78）and 48.7%（38/78）in BALF exosomes， serum and lung cancer tissues specimens respectively. EGFR detection showed no results in 3 cases and the false?negative rate was 6.4% （5/78） in BALF specimen， and false?negative rate was 16.7% （13/78） in serum. The detection coincidence rate of EGFR mutation was 86.8% （33/38） in BALF exosomes specimen， and 65.8% （25/38） in serum. Conclusions EGFR gene mutation rate in BALF exosome specimen is consistent with that in serum and lung cancer tissue samples， showing no statistical significance （P > 0.05）. It is superior to serum specimen and suitable for patient screening before targeted therapy and provides new ideas and screening methods for early individualized treatment decisions of advanced NSCLC patients.