宏基因组二代测序在儿童骨关节感染中的临床价值  

Clinical Value of Metagenomic Next-generation Sequencing in Children with Osteoarticular Infections

作　　者：马健 高静[1] 秦攀[1] Ma Jian;Gao Jing;Qin Pan(The First Affiliated Hospital of Zhengzhou University,ZhengZhou 450000,China)

机构地区：[1]郑州大学第一附属医院小儿外科,郑州450000

出　　处：《河南外科学杂志》2023年第4期28-31,共4页Henan Journal of Surgery

摘　　要：目的 探讨宏基因组二代测序(mNGS)在儿童骨关节感染(OAI)中的临床应用价值。方法 收集2021-01—2022-10于郑州大学第一附属医院小儿外科拟诊为OAI的25例患儿的临床资料,其中10例送检标本为外周血标本,15例为开放性手术标本。所有标本均进行常规培养和mNGS检测。以最终临床诊断标准为依据,比较常规培养和mNGS对OAI的诊断效能,并分析抗生素使用情况和标本类型对二者检出率的影响。结果 根据最终临床诊断标准确诊为OAI患儿21例,4例为非OAI。mNGS检测用时(109.1±18.7)h(范围:72~168 h),常规培养为(29.7±8.6)h(范围:24~48 h)。mNGS检测阳性16例,假阳性1例,敏感度为76.2%,特异度为75.0%;常规培养阳性5例,敏感度为23.8%,特异度为100.0%。二者病原体检测用时、敏感度间的差异有统计学意义(P<0.05),而特异度的差异无统计学意义(P=1.00)。在标本送检前行抗生素治疗的13例患儿中,mNGS检出率76.9%,常规培养检出率为23.1%;在14例手术标本中,mNGS检出率为71.4%,常规培养检出率为21.4%。差异均有统计学意义(P<0.05)。结论 在儿童OAI的病原体诊断中,mNGS具有较高的敏感度,检测用时短,且检出率受既往抗生素治疗的影响更小。Objective To explore the clinical application value of metagenomic second-generation sequencing(mNGS)in children with bone and joint infection.Methods The clinical data of 25 children with osteoarticular infection in the First Affiliated Hospital of Zhengzhou University from January 2021 to October 2022 were collected,including 10 cases of peripheral blood samples and 15 cases of open surgery samples.All samples were tested by routine and mNGS.Taking the final clinical diagnosis as a reference,this paper compares the difference of diagnostic efficiency between conventional culture and mNGS for bone and joint infection,and analyze the influence of antibiotic use and specimen type on the detection rate of both.Results According to the diagnostic criteria agreed by experts,21 cases were diagnosed as bone and joint infection and 4 cases were uninfected.The detection time of mNGS was(109.1±18.7)h,and the routine culture time was(29.7±8.6)h.There were 16 cases and false positive in 1 case in mNGS,the sensitivity was 76.2%and specificity was 75.0%.5 cases were positive in routine culture,with a sensitivity of 23.8%and a specificity of 100.0%.The difference between them in time-consuming and sensitivity of pathogen detection was statistically significant(P<0.05),but there was no statistical difference in specificity(P=1.000).Among the 13 children who received antibiotic treatment before the samples were submitted for examination,the detection rates of mNGS and routine culture were 76.9%and 23.1%,respectively,and there was significant difference between them(P<0.05).In 14 surgical specimens,the detection rate of mNGS was 71.4%,and that of routine culture was 21.4%,and the difference between them was statistically significant(P<0.05).Conclusion In the pathogen diagnosis of osteoarticular infection in children,mNGS has high sensitivity and short detection time,and the detection rate is less affected by previous antibiotic treatment.

关 键 词：宏基因组二代测序 骨髓炎 化脓性关节炎 金黄色葡萄球菌 

分 类 号：R681.2[医药卫生—骨科学]