宏基因组二代测序在骨关节感染病原学诊断中的应用价值  

Application Value of Metagenomic Second-Generation Sequencingin Etiological Diagnosis of Bone and Joint Infection

作　　者：宋燕华[1] 周子博 闫亚芳 SONG Yanhua;ZHOU Zibo;YAN Yafang(Laboratory Medicine,Zhengzhou Orthopaedic Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州市骨科医院检验科,河南郑州450000

出　　处：《河南医学研究》2024年第24期4471-4474,共4页Henan Medical Research

摘　　要：目的 分析宏基因组二代测序(mNGS)在骨关节感染病原学诊断中的应用价值。方法 将郑州市骨科医院2020年4月至2023年4月收治的63例疑似骨关节感染患者作为研究对象。均行传统培养法、mNGS检测,以临床综合诊断结果为“金标准”,统计传统培养法、mNGS检测骨关节感染的检测结果和检测灵敏度;比较传统培养法、mNGS检测方法鉴定病原菌类型的结果;比较骨关节感染患者不同治疗方案治疗前和治疗后白细胞计数(WBC)、红细胞沉降率(ESR)、C反应蛋白(CRP)变化。结果 63例疑似骨关节感染患者,临床综合诊断确诊阳性41例、阴性22例;传统培养法培养出真阳性25例、真阴性19例;采用mNGS检测出真阳性34例,真阴性20例。mNGS检测灵敏度[82.93%(34/41)]高于传统培养法[60.98%(25/41)](P<0.05)。传统培养法培养出43株病原菌,mNGS检测出51株病原菌,均以金黄色葡萄球菌、凝固酶阴性葡萄球菌为主,其次为阴沟肠杆菌、肠球菌、布氏杆菌、链球菌、结核分枝杆菌。基于mNGS结果的靶向治疗方案治疗后WBC、ESR、CRP水平低于经验性治疗方案(P<0.05)。结论 mNGS检测应用于骨关节感染病原学诊断中,可提高诊断灵敏度,准确鉴定感染病原菌类型,有利于提高抗感染治疗效果。Objective To analyze the application value of metagenomic second-generation sequencing(mNGS)in the etiological diagnosis of bone and joint infection.Methods A total of 63 patients with suspected bone and joint infection admitted to Zhengzhou Orthopaedic Hospital from April 2020 to April 2023 were selected as the study objects.Traditional culture method and mNGS detection were performed.Clinical comprehensive diagnosis was taked as the“gold standard”.The detection results and sensitivity of bone and joint infection detected by traditional culture method and mNGS were analyzed.The results of identification of pathogenic bacteria types were compared between traditional culture method and mNGS detection method.The changes of white blood cell count(WBC),erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)in patients with osteojoint infection were compared before and after treatment.Results Of 63 suspected patients with bone and joint infection,41 were positive and 22 were negative.The traditional culture method produced 25 true positive cases and 19 true negative cases.There were 34 true positive cases and 20 true negative cases detected by mNGS.The sensitivity of mNGS was 82.93%(34/41),higher than that of traditional culture method[60.98%(25/41)](P<0.05).Forty-three strains of pathogenic bacteria were cultured by traditional culture method,and 51 strains were detected by mNGS.Staphylococcus aureus and coagulase negative staphylococcus were the main pathogens,followed by enterobacter cloacae,enterococcus,brucella,streptococcus and Mycobacterium tuberculosis.The levels of WBC,ESR and CRP after targeted therapy based on mNGS results were lower than those of empirical therapy(P<0.05).Conclusion The application of mNGS detection in the etiological diagnosis of bone and joint infection can improve the diagnostic sensitivity,accurately identify the types of infection pathogens,and improve the efficacy of anti-infection treatment.

关 键 词：骨关节感染 宏基因组二代测序 病原学 

分 类 号：R446.5[医药卫生—诊断学]