宏基因组测序在儿童急性细菌性脑膜炎中的临床应用  

Clinical application of metagenomics sequencing in children with acute bacterial meningitis

作　　者：虞雄鹰[1] 李小燕[1] 易招师[1] 查剑[1] 孙小兰 章静静[1] 陈辉[1] 黄志新[1] 钟建民[1] Yu Xiongying;Li Xiaoyan;Yi Zhaoshi;Zha Jian;Sun Xiaolan;Zhang Jingjing;Chen Hui;Huang Zhixin;Zhong Jianmin(Department of Neurology,Jiangxi Province Children′s Hospital,Nanchang 330006,China)

机构地区：[1]江西省儿童医院神经内科,南昌330006

出　　处：《中华实用儿科临床杂志》2021年第13期1007-1010,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨宏基因组测序在儿童细菌性脑膜炎(BM)病原学诊断中的应用价值,改善儿童BM的诊疗效果。方法收集2018年2月1日至2020年1月31日江西省儿童医院所有BM病例,同时采集其血和脑脊液等生物样本进行传统病原学检测和宏基因组测序,以传统病原学检测结果为金标准,明确宏基因组测序在儿童BM诊断的特异性和敏感性。结果入组45例,其中男31例,女14例;年龄(74.74±58.67)个月。宏基因组测序明确病原学共26例,阳性率为57.78%。其中肺炎链球菌8例,大肠埃希菌、脑膜炎奈瑟菌、葡萄球菌、沙门菌、复合分枝杆菌各2例,中间链球菌、化脓性链球菌、巴黎链球菌、液链球菌、流感嗜血杆菌、铜绿假单胞菌、鲍曼不动杆菌、曲霉菌各1例。传统的病原学阳性率为17.78%,宏基因组二代测序技术(mNGS)阳性率为57.78%,P=0.014,Kappa值为0.273。二者比较发现,mNGS技术在儿童BM诊断中灵敏度为100.00%,特异度为51.35%,阳性预测值为30.76%,阴性预测值为100.00%,Youden指数为51.36%,误诊率为48.64%,漏诊率为0。结论宏基因组学检查具有极高的敏感性,可提高儿童急性BM的病原学诊断率,尤其在临床高度怀疑感染,而传统病原学无法明确病原时应尽早选择。Objective To explore the application value of metagenomics sequencing in the etiological diagnosis of bacterial meningitis(BM)in children and improve the diagnosis and treatment effect of BM in children.Methods All BM cases were collected from Jiangxi Provincial Children′s Hospital from February 1,2018 to January 31,2020.Meanwhile,such biological samples as blood and cerebrospinal fluid were collected for traditional etiological testing and metagenomics sequencing.The results of traditional etiological testing were regarded as the gold standard,and the specificity and sensitivity of metagenomics sequencing in the diagnosis of BM in children were confirmed.Results A total of 45 cases were collected in this study,including 31 males and 14 females,with the age between(74.74±58.67)months.Twenty-six cases were identified by metagenomics sequencing,with the positive rate being 57.78%.Among them,there were 8 cases of Streptococcus pneumoniae,2 cases of Escherichia coli,2 cases of Neisseria meningitidis,2 cases of Staphylococcus,2 cases of Salmonella,2 cases of Mycobacterium multiplex,1 case of Streptococcus intermedius,1 case of Streptococcus pyogenes,1 case of Streptococcus paris,1 case of Streptococcus salivarius,1 case of Haemophilus influenzae,1 case of Pseudomonas aeruginosa,1 case of Acinetobacter baumannii,and 1 case of Aspergillus.The traditional etiological positive rate was 17.78%,and the metagenomic next-generation sequencing(mNGS)positive rate was 57.78%(P=0.014,kappa=0.273).As per the comparison results,the sensitivity,specificity,positive predictive value,negative predictive value,Youden index and misdiagnosis rate were 100.00%,51.35%,30.76%,100.00%,51.36%,48.64%and 0,respectively.Conclusions Metagenomics examination had high sensitivity,which can improve the etiological diagnosis rate of acute BM in children,especially in case of high clinical suspicion of infection.Therefore,metagenomics examination should be selected as early as possible when the etiology cannot be determined by traditional approache

关 键 词：宏基因 病原学 细菌性脑膜炎 儿童 

分 类 号：R742.9[医药卫生—神经病学与精神病学]