宏基因组学第二代测序技术对比传统实验室微生物培养在脓毒症病原学诊断中的优势  

The advantages of metagenomic next-generation sequencing compared with traditional laboratory microbial culture in the pathogen diagnosis of sepsis

作　　者：张淋 洪城[2] 孟新科[1] 李颖[1] Zhang Lin;Hong Cheng;Meng Xin-Ke;Li Ying(Intensive Care Unit,the second Hospital of Shenzhen,Shenzheng 518035,China)

机构地区：[1]深圳市第二人民医院重症医学科,广东深圳518035 [2]广州医科大学附属第一医院广州呼吸健康研究院呼吸疾病国家重点实验室/国家呼吸系统疾病临床医学研究中心呼吸与危重症医学科广州呼吸健康研究院,广东广州510010

出　　处：《中国急救医学》2022年第2期114-120,共7页Chinese Journal of Critical Care Medicine

摘　　要：目的通过对宏基因组学第二代测序技术(mNGS)获得的病原体与实验室培养结果进行对比,了解mNGS在脓毒症病原学诊断中的优势及其临床指导意义。方法将入选的脓毒症患者的标本(肺泡灌洗液、痰液、血液、脑脊液、胸水、腹水、分泌物等)同时送检mNGS和实验室细菌培养,对结果进行对比分析,评价mNGS在脓毒症病原学诊断方面的临床价值。结果mNGS的阳性率为78.9%;细菌培养的阳性率为40.4%(P<0.05)。通过mNGS共检出致病病原体57种,其中细菌31种,真菌16种,病毒7种,非典型病原体3种;细菌培养共检出病原体24种,其中细菌18种,真菌6种。以培养结果为金标准,mNGS的敏感度为76.2%,特异度为29.8%,阳性预测值为42.3%,阴性预测值为64.8%。根据病原学结果的抗生素调整将患者分为三组:按mNGS调整为mNGS组、经验性调整为经验组、按培养结果调整为传统培养组。mNGS组ICU住院时间更短(P<0.05),培养组降钙素原下降更明显(P<0.05)。结论mNGS在感染性疾病病原体的诊断方面较传统微生物培养时间更短,阳性率更高,在少见病原体、罕见病原体诊断方面有显著优势,可缩短患者ICU住院时间。Objective To compare the pathogens obtained by metagenomic next-generation sequencing(mNGS)with the results of laboratory culture in order to understand the advantages and clinical significance of mNGS in the pathogen diagnosis of sepsis.Methods Samples from selected patients with sepsis(bronchoalveolar lavage fluid,sputum,blood,cerebrospinal fluid,hydrothorax,ascites,secretion,etc.)were sent to mNGS and laboratory bacterial culture at the same time.The results were compared and analyzed to evaluate the clinical value of mNGS in pathogen diagnosis.Results The positive rate of mNGS was 78.9%,the positive rate of bacterial culture was 40.4%(P<0.05).A total of 57 species of pathogenic pathogens were detected by mNGS,including 31 species of bacteria,16 species of fungi,7 species of virus and 3 species of atypical pathogen.24 species of pathogens were detected by bacterial culture,including 18 species of bacteria and 6 species of fungi.Taking the culture results as the gold standard,the sensitivity,specificity,positive predictive value and negative predictive value of mNGS were 76.2%,29.8%,42.3%and 64.8%.The patients with antibiotic adjustment according to the pathogen results were divided into three groups:one group with the adjustment according to mNGS(mNGS group),the second group with empirically adjusted method(experience group),the third group with the adjustment according to the culture results(traditional culture group).The ICU hospitalization time in mNGS group was shorter(P<0.05),and the procalcitonin decreased more significantly in the traditional culture group(P<0.05).Conclusions mNGS has shorter time and higher positive rate than traditional microbial culture in the pathogen diagnosis of infectious diseases,there′s a significant advantage in rare pathogens,and can shorten the ICU hospitalization time of patients.

关 键 词：宏基因组学第二代测序技术(mNGS) 微生物培养 脓毒症 感染 病原体 

分 类 号：R459.7[医药卫生—急诊医学] R446.5[医药卫生—治疗学]