mNGS在血液恶性肿瘤患者疑似血流感染诊断中应用价值  

作　　者：宋晓露[1] 陈一瑞[1] 彭也[1] 杨浩 蓝建平[1] 

机构地区：[1]浙江省人民医院(杭州医学院附属人民医院),310014 [2]杭州迪安医学检验中心有限公司/浙江省数字医学诊断技术重点实验室,310030

出　　处：《浙江临床医学》2022年第9期1376-1377,1380,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省自然科学基金资助项目(LY20H080009);浙江省医药卫生科技项目(2020KY015)。

摘　　要：目的比较宏基因组二代测序(mNGS)技术与传统标准病原菌检测(血培养)在血液恶性肿瘤患者疑似合并血流感染治疗过程中的优效性,评估临床应用价值.方法回顾性分析2020年1月至2021年7月74例血液恶性肿瘤疑似血流感染患者的临床资料,从检测报告周期、病原菌检出率、指导用药获益程度等方面比较血培养和mNGS检测致病病原菌的优效性.结果mNGS阳性检出占78.38%,血培养阳性检出占10.81%;其中mNGS检测致病菌结果与临床综合诊断匹配相符占72.97%.血培养阳性的8例患者中,mNGS与血培养一致占75%;血培养阴性且mNGS检测阳性52例患者中,根据mNGS结果指导用药后患者病情转好占57.69%.mNGS检测报告周期2.5 d,血培养检测报告周期5 d.结论mNGS检测明显短于血培养检测报告周期,且病原菌阳性检出率、病原菌检测多样性和指导临床医师精准用药均优于传统血培养,尤其在血培养结果呈阴性情况下,mNGS可作为一种快速有效的辅助诊断方式,同时为临床医师由经验性治疗转向精准治疗提供科学依据,具有良好的临床应用价值.Objective To compare the eficacy between the metagenomic next-generation sequencing(mNGS)-based detection technique and the traditional standard pathogen detection in the tratment of blood malignant tumor patients with suspected bloodstream infection,and to comprehensively evaluate the clinical application value.Methods 74 patients with suspected blodstram infection in our hospital fom January 2020 to July 2021 were analyzed retrospectively.The eftivenes of clinical gold standard blood culture and mNGS detection of pathogenic bacteria were expounded from the aspects of detection and reporting cycle,detection rate of pathogens and beneft degree of guiding drug use.Results Overall,the positive rates of mNGS and blood culture were 78.38%and 10.81%,respectively.Among them,the results of mNGS detection of pathogenic bacteria were consistent with the clinical comprehensive diagnosis accounted for 72.97%.Among the 8 patients with positive local blood culture,75%of the patients with positive mNGS and blood culture were consistent with the blood culture,and 57.69%of the 52 paients with negative blood culture and positive mNGS test were improved according to the mNGS resuts.The mNGS test report period was 2.5 days and Merieux blood culure tet report cydle was 5 days.Conclusion The mNGS detection greatly shortens the reporting cycle,and the positive detection rate of pathogens,the diversity of pathogens detection and the guidance of accurate drug use for clinicians are better than those of traditional blood culure.Especally when the blood culture resuls are negative,mNGS can be used as a rapid and efecive auxiliary diagnostic method.At the same time,it provides a strong scientific basis for clinicians to shift from empirial treatment to accurate treatment,and has good clinical application value.

关 键 词：宏基因组二代测序 血培养 病原菌 血液恶性肿瘤 经验性治疗 精准治疗 血流感染 

分 类 号：R733[医药卫生—肿瘤]