宏基因组学二代测序在不明原因发热患者病原体检测中的应用  

Application of metagene next-generation sequencing in the detection of pathogens in patients with the fever of unknown origin

作　　者：张彬[1] 张弦[1] 赵华[1] 顾宇峰[1] 周跃[1] 金爱萍[2] 谭晓慧[1] 张海峰[1] ZHANG Bin;ZHANG Xian;ZHAO Hua;GU Yufeng;ZHOU Yue;JIN Aiping;TAN Xiaohui;ZHANG Haifeng(Department of Infectious Diseases,the Affiliated Hospital of Nantong University,Jiangsu 226001;Department of Imaging,the Affiliated Hospital of Nantong University,Jiangsu 226001)

机构地区：[1]南通大学附属医院感染性疾病科 [2]南通大学附属医院影像中心,江苏226001

出　　处：《交通医学》2020年第2期131-135,共5页Medical Journal of Communications

基　　金：南通市科技局2018-民生科技-面上项目(MS12018046)。

摘　　要：目的:分析宏基因组学二代测序(mNGS)技术在不明原因发热患者病原检测中的应用价值。方法:选择不明原因发热51例患者,留取可疑部位标本送传统细菌培养,同时外送进行病原mNGS检测。比较细菌培养与mNGS病原二代测序结果,统计病原微生物检出敏感性、特异性、诊断效能等。结果:51例患者中传统培养共检出细菌8例(含结核分枝杆菌1例),真菌4例,病原mNGS在30份标本中鉴定出60个病原体,其中细菌22例(含结核分枝杆菌4例)、真菌12例,mNGS检出的病原体数量和种类明显多于传统培养。病原mNGS检测阳性率41.18%(21/51),高于传统培养阳性率23.53%(12/51),差异有统计学意义(P=0.012)。病原mNGS检测细菌、真菌的灵敏度,特异性,阳性预测值,阴性预测值和约登指数分别为91.67%,74.36%、52.38%、96.67%、0.6603,将mNGS检测到的病毒、支原体计算在内,检测阳性率从传统培养的23.53%(12/51)增至60.78%(31/51)。结论:mNGS用于临床病原学检测较传统培养更敏感,有助于不明原因发热患者的诊断和抗菌药物的合理使用。Objective:To observe the application value of metagenomics next-generation sequencing(mNGS)technology in the detection of pathogens in patients with unknown fever,in order to be precise screening of pathogens and rational selection of appropriate antibiotic treatment.Methods:In this study 51 non-immunity-deficient inpatients with FUO from the affiliated hospital of Nantong University from July 2018 to October 2019 were observed.The cause of fever of these patients with FUO could not be identified by routine comprehensive preliminary screening.After these FUO patients antibacterial drugs were stopped for more than 12 hours and fever samples from the suspicious area were taken again and sent to the bacterial and fungal culture of the microbiology room of our hospital.At the same time,samples from the suspicious area were taken for Quantitative mNGS.After the culture and mNGS pathogen detection results were issued by the laboratory,clinicians would comprehensively analyze and interpret reports based on their rich clinical experience,patient specific conditions combined with imaging culture results and eliminate background pathogen detection Positive results,identify pathogenic pathogens related to FUO and then treat them accurately to observe the effect.After comparison and analysis of the results of the pathogenic microorganism culture and the mNGS pathogens,the sensitivity,specificity,and diagnostic efficacy of the two methods for the detection of pathogenic microorganisms were counted.Results:Among 51 patients,21 cases of bacteria,fungi,and Mycobacterium tuberculosis were found in the pathogenic mNGS,and 12 cases were confirmed by traditional culture.Eleven specimens were detected for bacteria,fungi,or Mycobacterium tuberculosis by traditional culture and pathogenic mNGS.Among them,the number of pathogens detected in pathogenic mNGS specimens was significantly higher than that of traditional cultures,especially pathogens that could not be obtained from cultures such as viruses and mycoplasma;in another specimen b

关 键 词：不明原因发热 宏基因组学二代测序 细菌培养 病原体 

分 类 号：R441.3[医药卫生—诊断学]