脑脊液mNGS与传统培养在不同病原中枢神经系统感染性疾病鉴别诊断中的差异性  

Differential diagnosis of central nervous system infectious diseases with different pathogens by mNGS and traditional culture in cerebrospinal fluid

作　　者：徐小汝 陈路明 王姗姗 苏丹丹 王辛程 XU Xiao-ru;CHEN Lu-ming;WANG Shan-shan;SU Dan-dan;WANG Xin-cheng(The 928th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army,Haikou,Hainan 570100,China)

机构地区：[1]中国人民解放军联勤保障部队第九二八医院神经内科,海南海口570100 [2]中国人民解放军联勤保障部队第九二八医院全科医学,海南海口570100

出　　处：《中华医院感染学杂志》2023年第23期3532-3536,共5页Chinese Journal of Nosocomiology

基　　金：海南省自然科学基金面上项目(822MS192)。

摘　　要：目的研究脑脊液宏基因组测序(mNGS)与传统培养在不同病原中枢神经系统感染性疾病鉴别诊断中的差异性。方法选取2017年6月-2022年6月中国人民解放军联勤保障部队第九二八医院收治的87例中枢神经系统疾病患者,以临床诊断标准将患者分成病毒性脑炎组(n=52)、结核性脑膜炎组(n=9)、化脓性脑膜炎组(n=21)和隐球菌性脑膜炎组(n=5)。所有患者均接受脑脊液mNGS和传统培养,计算、比较两种方式对不同病原体神经系统疾病的敏感度、特异度等诊断效能指标。结果病毒性脑炎mNGS在Unique reads条数≥2,敏感度为76.92%,特异度为88.57%,传统培养敏感度为32.69%,特异度为74.29%;mNGS在发现结核分枝杆菌序列数>1时敏感度为55.56%,特异度为70.51%,传统培养敏感度为44.44%,特异度为69.23%;化脓性脑膜炎mNGS在Unique reads条数≥5,敏感度为71.43%,特异度为90.91%,传统培养敏感度为47.62%,特异度为65.15%;mNGS发现隐球菌DNA时敏感度为60.00%,特异度为84.15%,传统培养敏感度为40.00%,特异度为76.83%。结论与传统培养方式相比,脑脊液mNGS应用于诊断不同病原体中枢神经系统感染性疾病的鉴别和感染具有显著的优势,为中枢神经系统疾病早期诊断提供快速、便捷及准确的方法。OBJECTIVE To investigate the differential diagnosis of central nervous system infectious diseases with different pathogens by mNGS and traditional culture in cerebrospinal fluid.METHODS A total of 87 patients with central nervous system diseases admitted to the 928th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from Jun 2017 to Jun 2022 were recruited and divided into the viral encephalitis group(n=22),tuberculous meningitis group(n=29),suppurative meningitis group(n=23)and cryptococcal meningitis group(n=13)according to clinical diagnostic criteria.Cerebrospinal fluid of all patients were sent for mNGS and traditional bacterial culture.The sensitivity and specificity of the two methods for the diagnosis of neurological diseases with different pathogens were calculated and compared.RESULTS When the unique reads≥2,mNGS of the viral encephalitis group had the sensitivity of 76.92%,specificity of 88.57%,and the sensitivity and specificity of the traditional culture were 32.69% and 74.29%,respectively.The sensitivity and specificity of mNGS for the detection of CSF unique reads>1 were 55.56%and 70.51%,respectively.When the sequence number of Mycobacterium tuberculosis was greater than 1,the sensitivity and specificity of traditional culture were 44.44% and 69.23% respectively.When the unique reads≥5,the sensitivity of mNGS assay of the suppurative meningitis group was 71.43%,with the specificity of 90.91%;and the sensitivity and specificity of traditional culture were 47.62% and 65.15%,respectively.The sensitivity and specificity of Cryptococcal DNA detected by mNGS were 60.00% and 84.15%,respectively;and those by the traditional culture were 40.00% and 76.83%,respectively.CONCLUSION Compared with the traditional culture method,mNGS has significant advantages in the diagnosis of different pathogens in the identification of infection in central nervous system infectious diseases,providing a rapid,convenient and accurate method for the early diagnosis of central nervous syst

关 键 词：宏基因组测序 病毒性脑炎 化脓性脑膜炎 结核性脑膜炎 隐球菌性脑膜炎 脑脊液 诊断效能 

分 类 号：R529.3[医药卫生—内科学]