宏基因二代测序在腹膜透析相关腹膜炎病原学诊断中的应用  

Etiological diagnostic value of metagenomic next-generation sequencing in peritoneal dialysis-related peritonitis

作　　者：张庆燕[1] 金波[1] 冯媛[1] 钱凯 王华[1] 万骋[1] 徐鹏飞 张苗[1] 蒋春明[1] Zhang Qingyan;Jin Bo;Feng Yuan;Qian Kai;Wang Hua;Wan Cheng;Xu Pengfei;Zhang Miao;Jiang Chunming(Department of Nephrology,the Affiliated Drum Tower Hospital,Medical School of Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院肾内科,南京210008

出　　处：《中华肾脏病杂志》2023年第1期8-12,共5页Chinese Journal of Nephrology

基　　金：南京市卫生科技发展专项(YKK21090);南京大学医学院附属鼓楼医院临床研究专项(2021-LCYJ-PY-12)。

摘　　要：目的探讨宏基因二代测序(metagenomic next-generation sequencing,mNGS)在腹膜透析(peritoneal dialysis,PD)相关腹膜炎病原学诊断中的价值。方法该研究为回顾性队列研究。分析2020年6月至2021年7月在南京大学医学院附属鼓楼医院就诊并同时留取PD流出液样本行病原体mNGS检测和微生物培养的PD相关腹膜炎患者的临床资料,比较mNGS检测和传统微生物培养对PD相关腹膜炎病原学诊断的阳性率、时效性和一致性。结果共18例PD相关腹膜炎患者纳入本研究,其中男性11例,女性7例,年龄(50.4±15.4)岁,中位透析龄34.0(12.4,62.0)个月。mNGS检测共有17例患者检出致病菌,阳性率为17/18,高于微生物培养的13/18,但差异无统计学意义(P=0.219)。两种检测方法均阳性的患者有12例,其中11例患者检出的致病菌一致;5例微生物培养阴性患者的mNGS检测为阳性,包括表皮葡萄球菌3例(1例同时检出表皮葡萄球菌和人葡萄球菌)、结核分枝杆菌1例及解脲脲原体1例;1例患者微生物培养阳性(大肠埃希菌)而mNGS检测阴性。mNGS检测报告时间显著低于微生物培养[25.0(24.0,27.0)h比89.0(72.8,122.0)h,Z=3.726,P<0.001]。结论mNGS对PD相关腹膜炎的病原体检测敏感性高,检出致病菌与微生物培养具有较好的一致性,并缩短了检出时间,可能成为PD相关腹膜炎特别是难治性腹膜炎病原体识别的新途径。Objective To explore the etiological diagnostic value of metagenomic next-generation sequencing(mNGS)in peritoneal dialysis(PD)-related peritonitis.Methods The study was a retrospective cohort study.The clinical data of patients with PD-related peritonitis who were treated and underwent microbial cultivation and mNGS test at the same time from June 2020 to July 2021 in the Affiliated Drum Tower Hospital,Medical School of Nanjing University were analyzed.The positive rate,detection time and consistency between mNGS test and traditional microbial culture were compared.Results A total of 18 patients with age of(50.4±15.4)years old and median dialysis time of 34.0(12.4,62.0)months were enrolled in the study,including 11 males and 7 females.Pathogenic microorganisms were isolated in 17 patients by mNGS test,with a positive rate of 17/18,which was higher than 13/18 of microbial culture,but the difference was not statistically significant(P=0.219).Both mNGS test and microbial culture isolated positive pathogenic bacteria in 12 patients,and mNGS test isolated the same types of pathogenic bacteria as microbial cultivation did in 11 patients.In five patients with negative microbial culture,mNGS test also isolated pathogenic microorganisms,including 3 cases of Staphylococcus epidermidis,1 case of Mycobacterium tuberculosis and 1 case of Ureaplasma urealyticum.In 1 patient,microbial culture isolated pathogenic bacteria(Escherichia coli)whereas mNGS test did not.The detection time of mNGS was 25.0(24.0,27.0)h,which was significantly shorter than 89.0(72.8,122.0)h of microbial culture(Z=3.726,P<0.001).Conclusions mNGS test can improve the detection rate of pathogenic microorganisms in PD-related peritonitis and greatly shorten the detection time,and has good consistency with microbial culture.mNGS may provide a new approach for pathogen identification of PD-related peritonitis,especially refractory peritonitis.

关 键 词：腹膜透析 腹膜炎 诊断 宏基因二代测序 病原学 

分 类 号：R459.5[医药卫生—治疗学]