纳米孔靶向测序技术快速检测复杂性尿路感染病原菌的临床价值  

Clinical study on the application of nanopore targeted sequencing technology for rapid and accurate detection ofpathogens inpatients with complicated urinary tract infections

作　　者：姜声明 柯鹄 熊云鹤[1] 廖文彪[1] 孟令超[1] 宋超[1] 陈亮[1] 吴天鹏[1] 杨嗣星[1] Jiang Shengming;Ke Hu;Xiong Yunhe;Liao Wenbiao;Meng Lingchao;Song Chao;Chen Liang;Wu Tianpeng;YangSixing(Department of Urology,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院泌尿外科,武汉430060

出　　处：《中华泌尿外科杂志》2023年第1期26-31,共6页Chinese Journal of Urology

摘　　要：目的探讨纳米孔靶向测序技术(NTS)检测复杂性尿路感染病原菌的临床价值。方法回顾性分析2020年7月至2021年6月武汉大学人民医院泌尿外科收治的326例复杂性尿路感染患者的临床资料。男224例, 女102例。年龄(56.88±14.58)岁。收集抗感染治疗前同一时间尿液样本分别行NTS及尿培养检测, 记录检测所耗时间和检测结果。采用χ^(2)检验、t检验、Wilcoxon秩和检验进行统计学分析, 比较两种检测方法病原菌检出率、检测所耗时间及检出菌种数量的差异。结果 326例中NTS和尿培养分别检出尿路微生物221例(67.80%)和78例(23.93%), NTS尿路微生物检出率显著高于尿培养(χ^(2)=130.25, P<0.01)。NTS和尿培养分别检出病原菌177例(54.29%)和76例(23.31%), NTS病原菌检出率显著高于尿培养(χ^(2)=38.95, P<0.01)。221例中NTS检出1种尿路微生物106例, 2种68例, ≥3种47例;78例中尿培养检出1种尿路微生物73例, 2种5例;NTS检出尿液微生物种类明显多于尿培养(Z=11.49, P<0.01)。NTS检出1种病原菌114例, 2种48例, ≥3种15例;尿培养检出1种病原菌71例, 2种5例;NTS检出病原菌种类明显多于尿培养(Z=9.67, P<0.01)。NTS检出尿路微生物的种类显著多于尿培养(Z=11.49, P<0.01), 其中病原菌种类亦显著多于尿培养(Z=9.67, P<0.01)。NTS与尿培养检测时长分别为(24.29±2.65)h与(49.28±11.30)h, 差异有统计学意义(t =39.48, P<0.01)。135例(41.41%)NTS与尿培养结果完全一致;150例(46.01%)NTS提示尿培养未检出的尿路微生物, 其中112例(34.36%)为病原菌;27例(8.28%)NTS除检出尿培养提示的病原菌外, 还检出更多病原菌。6例(1.84%)治疗后复查NTS可见首要病原菌reads数量值下降, 出现定植菌或条件致病菌生长。5例(1.53%)复查尿培养结果验证了入院时NTS检测结果, 其中2例(0.61%)入院时NTS可以覆盖后续多次尿培养病原菌。结论 NTS检测尿路感染病原菌具有快速、灵敏、全面的优势Objective To evaluate the clinical value of nanopore targeted sequencing(NTS)in pathogens detection in urinary tract by comparing the results of different tests performed on the same urine sample.Methods The results of NTS and urine culture test collected from 326 patients in the Department of Urology of People's Hospital of Wuhan University from July 2020 to June 2021 were retrospectively analyzed.There were 224 males and 102 females.The average age was(56.88±14.58)years old.X^(2) test and Student's test and Wilcoxon's sign rank test were used to analyze the differences of the pathogen detection rate,pathogen types results and detection time consuming between NTS and urine culture.The clinical value of the NTS in rapid detection of urinary pathogens was evaluated.Results Among 326 hospitalized patients,the urinary tract microbes'detecting rate of NTS was significantly higher than that of urine culture[67.80%(221/326)vs.23.93%(78/326),X^(2)=130.25,P<0.01].The uropathogens detecting rate of NTS was significantly higher than that of urine culture[54.29%(177/326)vs.23.31%(76/326),X^(2)=38.95,P<0.01].The number of urinary tract microbes detected by NTS was significantly higher than that of urine culture(Z=11.49,P<0.01),the number of uropathogens was significantly higher than that of urine culture(Z=9.67,P<0.01).The detection time of NTS and urine culture positive samples was(24.29±2.65)h and(49.28±11.30)h,the difference was statistically significant(t=39.48,P<0.01).The results obtained by using NTS and urine culture were consistent in 135(41.41%)samples.In 150(46.01%)samples,NTS could detect the urinary tract microbes while urine culture cannot find,of which 112 cases(34.36%)were uropathogenic.In 27 cases(8.28%),more pathogens were detected by NTS except those from urine culture.In 6 cases(1.84%)re-detecting NTS after antibiotic therapy,the number of reads of primary uropathogen decreased gradually with the growth of colonizing bacteria or opportunistic pathogens appeared in the end.Re-examinations of urine cultur

关 键 词：泌尿道感染 纳米孔测序 尿微生物群 菌尿 

分 类 号：R446.5[医药卫生—诊断学] R691.3[医药卫生—临床医学]