瓣膜宏基因二代测序在感染性心内膜炎病原学诊断中的应用  

Application of valve metagenomic next-generation sequencing in etiological diagnosis of infective endocarditis

作　　者：蔡思诗 杨晔 潘珏 缪青 黄英男 王青青 马玉燕 金文婷 高晓东[2] 鲍容 单玉璋 胡必杰 王春生[4] CAI Si-shi;YANG Ye;PAN Jue;MIAO Qing;HUANG Ying-nan;WANG Qing-qing;MA Yu-yan;JIN Wen-ting;GAO Xiao-dong;BAO Rong;SHAN Yu-zhang;HU Bi-jie;WANG Chun-sheng(Fudan University Zhongshan Hospital,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院感染病科,上海200032 [2]复旦大学附属中山医院心脏外科,上海200032 [3]复旦大学附属中山医院感染管理科,上海200032 [4]复旦大学附属中山医院微生物实验室,上海200032

出　　处：《中华医院感染学杂志》2020年第22期3404-3408,共5页Chinese Journal of Nosocomiology

基　　金：复旦大学附属中山医院临床研究专项基金(2018ZSLC06)。

摘　　要：目的探讨瓣膜宏基因二代测序(mNGS)在感染性心内膜炎(IE)病原学诊断中的临床应用价值。方法回顾性分析从2018年6月21日-2020年6月18日在复旦大学附属中山医院确诊为IE并行心脏瓣膜手术的30例患者(18例患者培养阳性,12例患者培养阴性)。对于培养阳性IE患者,以培养结果为金标准,研究瓣膜mNGS检测病原体的可靠性。对于培养阴性IE患者,研究瓣膜mNGS的病原体检出率。比较培养阳性IE患者和培养阴性IE患者瓣膜mNGS检出病原体属相对丰度、属严格序列数、覆盖率、种相对丰度以及种严格序列数差异。结果培养阳性IE患者,瓣膜mNGS结果同培养结果完全一致,敏感度和特异度均为100%。对培养阴性IE患者,瓣膜mNGS检出病原体阳性率为100%。培养阳性IE患者瓣膜mNGS检出病原体的属严格序列数、覆盖率、种相对丰度以及种严格序列数均高于培养阴性IE患者,两组患者瓣膜mNGS检出病原体的属相对丰度无显著差异。结论瓣膜mNGS诊断IE病原体的敏感度、可靠性高,为培养阴性IE患者明确病原体、精准化抗感染用药提供了新的途径。OBJECTIVE To evaluate the clinical value of valve metagenomic next-generation sequencing(mNGS) in etiological diagnosis of infective endocarditis(IE). METHODS The data of 30 patients who were diagnosed with IE and received valve surgery in Zhongshan Hospital of Fudan University from Jun 21, 2018 to Jun 18, 2020 were retrospectively analyzed. 18 patients were cultured positive, and 12 patients were cultured negative. For the IE patients who were cultured positive, the results of culture were set as gold standards so as to evaluate the sensitivity and specificity of valve mNGS in detection of pathogens. For the IE patients who were cultured negative, the isolation rates of pathogens were studied. The relative abundance of genera, strict sequence number of genera, coverage rate, relative abundance of species, and strict sequence number of species were observed and compared between the culture-positive IE patients and the culture-negative IE patients. RESULTS For the culture-positive IE patients, the results of valve mNGS were completely same as the results of culture, both the sensitivity and specificity were 100%. For the culture-negative IE patients, the positive rate of detection of pathogens was 100% with the valve mNGS. The strict sequence number of genera, coverage rate, relative abundance of species, and strict sequence number of species of the isolated pathogens with valve mNGS were higher in the culture-positive IE patients than in the culture-negative IE patients, there was no significant difference in the relative abundance of genera of the isolated pathogens between the two groups of patients. CONCLUSION The sensitivity and reliability of the valve mNGS are high in the diagnosis of pathogens, it can a new approach for identification of pathogens and precise use of antibiotics for the culture-negative IE patients.

关 键 词：宏基因二代测序 感染性心内膜炎 病原学诊断 

分 类 号：R542.4[医药卫生—心血管疾病]