基于ICU可疑感染患者探讨mNGS与传统病原学检测的相关性研究  

Study on the correlation between mNGS and traditional pathogen detection based on suspected infected patients in ICU

作　　者：李群 董晨明[1] 张芳[1] 鲍英存[1] 刘美 马玉梅[1] 袁琪茜 杨晓玲 张官文 LI Qun;DONG Chen-ming;ZHANG Fang;BAO Ying-cun;LIU Mei;MA Yu-mei;YUAN Qi-xi;YANG Xiao-ling;ZHANG Guan-wen(Lanzhou University Second Hospital,Lanzhou 730000,China)

机构地区：[1]兰州大学第二医院,甘肃兰州730000

出　　处：《中国病原生物学杂志》2022年第5期568-573,共6页Journal of Pathogen Biology

基　　金：甘肃省中医药管理局项目(No.GZKG-2020-47);甘肃省青年科技基金计划项目(No.20JR10RA761,21JR1RA159);兰州大学第二医院“萃英科技创新”计划项目(No.CY-2018-BJ14)。

摘　　要：目的 对可疑感染患者同时进行宏基因组二代测序(Metagenomics Next Generation Sequencing,mNGS)与传统病原学检测,对比检测结果并评估其异同点,为指导治疗和改善抗生素管理提供新的诊断证据和思路。方法 回顾性收集2018年7月至2020年8月兰州大学第二医院重症监护病房(ICU)内可疑感染患者电子病历系统信息、mNGS及传统病原学结果、药物、合并疾病、治疗效果等资料,根据检测方法分为mNGS组和传统病原组,由于传统培养可培养出细菌和真菌,传统病原组进一步根据是否行培养分为细菌组和非细菌组。根据结果评估mNGS与传统病原学结果的差异、病原体的一致性、mNGS结果报告后是否调整治疗以及其治疗效果。结果 剔除排除标准后共纳入90例可疑感染患者,符合可疑感染诊断标准的患者的7 d、28 d、院内死亡率分别为13.3%、14.4%和27.8%。患者感染部位最多见于肺部感染(87.8%),mNGS与传统病原组结果均显示细菌最多(43.3%、52.2%),其中,鲍曼不动杆菌(25.6%)、铜绿假单胞菌(10.0%)、肺炎克雷伯菌(6.7%)较为常见,其次为病毒(40%、12.2%),真菌(23.3%、17.8%),分枝杆菌(13.3%、21.1%),立克次体(3.3%、0.0%),寄生虫(2.2%、0.0%),支原体(1.1%、2.2%)。mNGS组与传统病原组(结合外送检查、影像学检查等)病原体阳性检出率均为70%,传统病原组中细菌组阳性率为51.1%。两组病原体一致率46.7%。mNGS组在检测细菌、真菌、分枝杆菌与传统病原组结果基本一致,而在检测病毒方面结果具有明显差异。进一步分析可见mNGS组在检测病毒方面比传统病原组具有优越性(Kappa检验,P<0.05)。预后分析发现,机械通气影响7 d、28 d以及院内死亡率,而且影响细菌组以及mNGS组培养结果。结论 本研究通过对比传统病原学检测结果,证实mNGS不仅具有一致性,在敏感性上更具有显著优势,mNGS在检测病毒方面比传统组具有优越性。预后分析�Objective In this study,detecte to mNGS and traditional pathogens and compare to the two results simultaneously in patients with suspected infection,In order to guide treatment and improve antibiotic management,and provide new diagnostic evidence and ideas.Methods Collecting the electronic medical information,mNGS and traditional etiology results,drugs,comorbid diseases and treatment effect of patients with suspected infection in the intensive care unit(ICU) of the second hospital of Lanzhou University in Gansu Province from July 2018 to August 2020.According to the detection methods,they were divided into mNGS group and traditional pathogen group.Because bacteria and fungi could be cultured in traditional culture,the traditional pathogen group was further divided into bacterial group and non bacterial group.Evaluation based on results the difference between mNGS and traditional etiological results,the consistency of pathogens,whether the treatment was adjusted and the therapeutic effect.Results A total of 90 patients with suspected infection were included after the exclusion criteria,and the 7-day,28-day and in-hospital mortality of the patients with suspected infection were 13.3%,14.4% and 27.8%,respectively.The most common site of infection was pulmonary infection(87.8%),the results of mngs and traditional pathogen group showed that the bacteria were the most(43.3%,52.2%).Among them,Acinetobacter baumannii(25.6%),Pseudomonas aeruginosa(10.0%),Klebsiella pneumoniae(6.7%) were more common,followed by viruses(40%,12.2%),fungi(23.3%,17.8%),Mycobacterium(13.3%,21.1%),rickettsia(3.3%,0.0%),parasites(2.2%,0.0%),and bronchiolitis(1%,2.2%).The positive rate of pathogens in mNGS group and traditional pathogen group(combined external examination with imaging examination) was 70%,and the positive rate of bacteria group in traditional pathogen group was 51.1%.The coincidence rate of pathogens in the two groups was 46.7%.The detection results of bacteria,fungi and mycobacteria in mNGS group were basically the same as those

关 键 词：可疑感染 宏基因二代基因测序 传统病原学 重症监护病房(ICU) 

分 类 号：R378[医药卫生—病原生物学]