血清NFP、MMP-2联合mNGS在儿童中枢神经系统感染的临床价值  

Clinical value of serum NFP and MMP-2 combined with mNGS in the diagnosis of central nervous system infections in children

作　　者：张晓蒙[1] 苏秦[1] 杨光路[1] 贾俊玲 朝鲁门其其格 李晓华[1] ZHANG Xiaomeng;SU Qin;YANG Guanglu;JIA Junling;CHAO Lumen qiqige;LI Xiaohua(Department of Pediatrics,Affiliated Hospital of Inner Mongolia Medical University,Hohhot,Inner Mongolia 010000,China)

机构地区：[1]内蒙古医科大学附属医院儿科,内蒙古呼和浩特010000

出　　处：《国际检验医学杂志》2023年第22期2739-2744,共6页International Journal of Laboratory Medicine

基　　金：2022年度自治区卫生健康科技计划项目(202201326);内蒙古医科大学“科技百万工程”项目(YKD2018KJBW-LH-019);2021年度内蒙古自治区科技厅项目(2021GG0209)。

摘　　要：目的探讨血清中神经丝蛋白(NFP)及基质金属蛋白酶-2(MMP-2)联合宏基因组二代测序技术(mNGS)检测在儿童中枢神经系统(CNS)感染中的临床价值。方法选取2020年9月至2022年3月该院儿科收治的临床初步诊断为CNS感染的120例患儿,采用随机数表法将其分为传统方法组及mNGS组,每组60例,另选取同期该院儿科门诊未患CNS感染疾病的患儿60例为正常组。采用酶联吸附试验测定正常组、传统方法组及mNGS组患儿血清中NFP、MMP-2的表达水平,采用聚合酶链式反应(PCR)测定NFP mRNA、MMP-2 mRNA的表达水平;正常组、传统方法组及mNGS组检测患儿脑脊液中病原菌种类、比较阳性检测率、评价使用抗感染药物对检测率的影响及两组患儿的痊愈率;采用Kappa检测mNGS组血清中NFP、MMP-2的阳性率与mNGS阳性率在检测儿童CNS感染中的一致性;绘制受试者工作特征(ROC)曲线,采用二元Logistic回归计算联合预测因子,评价NFP、MMP-2、mNGS及联合预测因子在诊断儿童CNS感染性疾病的性能。结果传统方法组及mNGS组血清中NFP及MMP-2表达水平明显高于正常组,且传统方法组及mNGS组NFP mRNA及MMP-2 mRNA阳性率高于正常组,差异有统计学意义(P<0.05)。mNGS组病原菌检出总阳性率高于传统方法组及正常组,差异有统计学意义(P<0.05),使用抗菌药物治疗对mNGS检出率并无影响(P>0.05),mNGS组住院14 d后痊愈率高于传统方法组,差异有统计学意义(P<0.05)。mNGS组中NFP阳性率与mNGS组总阳性率之间一致性Kappa值为0.85,MMP-2阳性率与mNGS组总阳性率之间一致性Kappa值为0.92,两者差异均有统计学意义(P<0.05)。在调整年龄、性别等因素后,血清NFP每上升1 ng/mL,儿童CNS感染的风险则增加0.054倍(OR=1.054,95%CI:1.006~1.103,P<0.001),血清MMP-2每上升1 ng/mL,儿童CNS感染的风险则增加0.022倍(OR=1.022,95%CI:1.010~1.035,P<0.001),mNGS阳性率每上升1%,儿童CNS感染的风险则增加0.387倍(OR=1.387,95%Objective To investigate the clinical value of serum neurofilament protein(NFP)and matrix metalloproteinase-2(MMP-2)combined with metagenomic next generation sequencing(mNGS)in children with central nervous system(CNS)infection.Methods A total of 120 children with initially diagnosed CNS infection admitted to the Department of Pediatrics,Affiliated Hospital of Inner Mongolia Medical University from September 2020 to March 2022 were randomly divided into traditional method group and mNGS group,and 60 children without CNS infection in the child health clinic of the hospital during the same period were selected as the normal group.The serum expression levels of NFP and MMP-2 in the normal group,the traditional method group and the mNGS group were measured by enzyme-linked immunosorbent assay,and the expression level of NFP mRNA and MMP-2 mRNA was measured by polymerase chain reaction(PCR).The normal group,traditional method group and mNGS group were used to detect pathogenic bacteria in cerebrospinal fluid of children,the positive detection rate was compared,the effect of anti-infective drugs on the detection rate was evaluated,and the cure rate of the two groups was evaluated.The positive rates of NFP and MMP-2 in the serum expression of the mNGS group were consistent with the positive rate of mNGS in the detection of CNS infection in children.Receiver operating characteristic(ROC)curve was drawn,and NFP,MMP-2,mNGS and co-predictors were calculated by binary Logistic regression to evaluate the performance of NFP,MMP-2,MNGS and co-predictors in the diagnosis of pediatric CNS infectious diseases.Results The serum levels expression of NFP and MMP-2 in the traditional method group and mNGS group were significantly higher than those in the normal group,and the positive rates of NFP mRNA and MMP-2 mRNA in the traditional method group and mNGS group were higher than those in the normal group,and the differences were statistically significant(P<0.05).The total positive rate of pathogenic bacteria in the mNGS group was high

关 键 词：神经丝蛋白 基质金属蛋白酶-2 中枢神经系统感染 儿童 宏基因组二代测序 

分 类 号：R725.5[医药卫生—儿科]