基于mNGS技术的病毒性中枢神经系统感染的流行病学特征及预后分析  

Analysis of the epidemiological characteristics and prognosis of viral central nervous system infections based on mNGS technology

作　　者：张晨晨 杨青松 任凯旋 陈晓阳 肖洒洒 张莹[1] ZHANG Chenchen;YANG Qingsong;REN Kaixuan;CHEN Xiaoyang;XIAO Sasa;ZHANG Ying(Shangqiu First People’s Hospital,Xinxiang Medical College,Shangqiu 476100,China)

机构地区：[1]新乡医学院附属商丘市第一人民医院,河南商丘476100

出　　处：《中国实用神经疾病杂志》2024年第12期1562-1566,共5页Chinese Journal of Practical Nervous Diseases

基　　金：2023年度河南省医学科技攻关计划项目(编号:LHGJ20230989)。

摘　　要：目的分析商丘市各种类型病毒的顺位、流行病学特征、预后的主要危险因素。方法选取2022-01—2024-02商丘市第一人民医院入院诊断疑似为中枢神经系统感染(ICNS)的175例患者为研究对象,所有患者入院后均行腰椎穿刺并完成脑脊液常规检查及宏基因组二代测序(m NGS)检查,收集入选患者的临床资料,分析各类病毒性ICNS的流行病学特征,应用多因素Logistic回归分析病毒性ICNS的相关危险因素。结果175例患者均完善脑脊液及mNGS检查,其中76例患者脑脊液中检出病原体,总检出率43.43%(76/175),最多见的是病毒57例,检出率32.57%(57/175),其中EB病毒(EBV)的检出率最高,为14.29%,其后依次为疱疹病毒1型(HSV-1)10.29%,巨细胞病毒(CMV)4.57%,水痘带状疱疹病毒(VZV)4%,细环病毒(TTV)2.86%,人类疱疹病毒7型(HHV-7)1.14%,B族肠道病毒(EV-B)和人类pegivirus(HPgV-1)0.57%。在不同性别中,EBV检出率有统计学差异(P<0.05),以男性多见。HSV-1在不同年龄段之间检出率有统计学差异(P<0.05),以>35~65岁年龄段检出率最高。病毒性ICNS的预后研究中显示早期意识障碍、血CRP升高与病毒性ICNS患者预后不良有相关性(P<0.05),早期意识障碍是病毒性ICNS患者预后不良的相关危险因素(P<0.05)。结论病毒谱的顺位为EBV、HSV-1、CMV、VZV、TTV、HHV-7、EV-B、HPgV-1。不同病原在性别、年龄之间检出率有差异,EBV以男性多见,HSV-1在>35~65岁年龄段多见。意识障碍是病毒性ICNS预后不良的相关危险因素。Objective To analyze the parity,epidemiological characteristics,and major risk factors for prognosis of various types of viruses in Shangqiu city.Methods Patients admitted to the First People’s Hospital of Shangqiu and diagnosed with central nervous system infections(ICNS)from January 2022 to February 2024 were selected as the study subjects,and all the enrolled patients underwent lumbar puncture and completed the routine cerebrospinal fluid examination and macro-genome second-generation sequencing(mNGS)examination after admission to the hospital,and the clinical data of the enrolled patients were collected to analyze the epidemiological characteristics of various types of viral ICNS.The risk factors associated with viral ICNS were analyzed by multifactorial Logistic regression analysis.Results Cerebrospinal fluid and mNGS examination were perfected in 175 patients,among which pathogens were detected in the cerebrospinal fluid of 76 patients,with a total detection rate of 43.43%(76/175),the most common viruses were found in 57 cases,with a detection rate of 32.57%(57/175),among which the detection rate of Epstein-Barr virus(EBV)was the highest,14.29%,followed by Herpesvirus type 1(HSV-1)with a detection rate of 10.29%,cytomegalovirus(CMV)with a detection rate of 4.57%,varicella zoster virus(VZV)with a detection rate of 4%,fine circulating virus(TTV)with a detection rate of 2.86%,human herpesvirus 7(HHV-7)with a detection rate of 1.14%,and enteroviruses of group B(EV-B)and human pegivirus(HPgV-1)with a detection rate of 0.57%.The detection rate was 0.57%for both.There was a statistically significant difference in the detection rate of EBV among different genders(P<0.05),with males being more common.There was a statistically significant difference on the detection rates of HSV-1 among different age groups(P<0.05),with the highest detection rate in the age group of>35-65 years.The prognostic study of viral ICNS showed that early impairment of consciousness and elevated blood CRP were correlated with poor prognosis

关 键 词：中枢神经系统感染 宏基因组二代测序 疾病谱 流行病学 预后 

分 类 号：R51[医药卫生—内科学]