宏基因组二代测序与细菌培养对儿童中枢神经系统感染的诊断价值比较  

Comparison of clinical diagnostic values of macrogenomic next-generation sequencing and bacterial culture in children with suspected central nervous system infections

作　　者：杨艳 祁亚平 田启运 YANG Yan;QI Yaping;TIAN Qiyun(Pediatric Intensive Care Unit,Luohe Second People's Hospital,Luohe,He'nan 462000,China)

机构地区：[1]漯河市第二人民医院儿科重症监护室,河南漯河462000

出　　处：《安徽医药》2025年第4期777-780,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的比较宏基因组二代测序(mNGS)与细菌培养对疑似中枢神经系统感染(CNSI)儿童的临床诊断价值。方法收集2020年6月至2023年1月于漯河市第二人民医院住院的疑似CNSI病儿120例脑脊液标本,并行mNGS检测和细菌培养。计算诊断CNSI的灵敏度、特异度、阳性预测值、阴性预测值,评估两种方法诊断CNSI的临床价值,比较两种方法送检至收到反馈结果的时间。结果纳入的120例疑似CNSI病儿中,临床诊断出CNSI病人78例。mNGS阳性70例,细菌培养阳性30例,两种检验方法结果相一致的26例,细菌培养结果阴性而mNGS结果阳性30例,在42例非CNSI病人中,mNGS阳性但细菌培养阴性病人4例,两种检测方法结果均为阴性4例。mNGS检测出的革兰阴性菌、革兰阳性菌、病毒和真菌检出构成比依次降低(64.3%>20.0%>11.4%>4.3%),细菌培养检测出的30例阳性均为革兰阴性菌。根据CNSI临床诊断标准,mNGS和细菌培养诊断CNSI的灵敏度为89.7%、38.5%,特异度为83.3%、100.0%,阳性预测值为90.9%、100.0%,阴性预测值为81.4%、46.7%,mNGS诊断CNSI的曲线下面积(AUC)95%CI为0.88(0.81,0.95)高于细菌培养诊断CNSI的AUC 95%CI为0.65(0.54,0.76)(P<0.05)。mNGS检测自标本送检至临床医师收到结果所用时间为(38.36±4.85)h显著低于细菌培养(198.51±8.47)h(t=26.35,P<0.001)。mNGS检测细菌阳性的结果反馈时间(32.47±3.14)h显著低于细菌培养(92.68±10.52)h(t=15.63,P<0.001)。结论mNGS对疑似CNSI的病儿具有较高的临床效能,病原体检测出率高,更有利于指导临床用药。Objective To compare the clinical diagnostic values of metagenomic next-generation sequencing(mNGS)and bacterial culture(referred to as traditional culture)for suspected central nervous system infections(CNSI)in children.Methods We collected cerebrospinal fluid samples from 120 suspected CNSI children admitted to the Second People's Hospital of Luohe City from June 2020 to January 2023,and performed mNGS testing and bacterial culture.Calculations were made of the sensitivity,specificity,positive predictive value,and negative predictive value for the diagnosis of CNSI.The clinical values of the two methods were evaluated,and the time from sending for testing to receiving feedback results for the two methods was compared.Results Among the included 120 suspected CNSI children,78 cases were confirmed.There were 70 cases positive for mNGS and 30 positive for bacterial culture,with 26 cases having consistent results of the two detection methods,and 30 cases negative for bacterial culture but positive for mNGS.Among 42 cases clinically diagnosed as non-CNSI,4 cases were positive for mNGS but negative for bacterial culture and 4 cases negative for both detection methods.The proportions of gram-negative bacteria,gram-positive bacteria,viruses and fungi detected by mNGS decreased successively(64.3%>20.0%>11.4%>4.3%),and 30 positive cases were all gram-negative bacteria detected by bacterial culture.Based on CNSI clinical diagnostic criteria,the sensitivities of mNGS and bacterial culture were 89.7%,38.5%,specificities 83.3%,100.0%,positive predictive values 90.9%,100.0%,and negative predictive values 81.4%,46.7%.The AUC 95%CI of CNSI di-agnosed by mNGS was higher than that by traditional culture[0.88(0.81,0.95)vs.0.65(0.54,0.76),P<0.05].The time of mNGS detection from sending for testing to clinicians receiving detection results was significantly shorter than that of bacterial culture[(38.36±4.85)h vs.(198.51±8.47)h,t=26.35,P<0.001].The feedback time for positive bacteria detected by mNGS was significantly shorter than t

关 键 词：中枢神经系统感染 宏基因组二代测序 脑脊液 细菌培养 儿童 

分 类 号：R742.9[医药卫生—神经病学与精神病学]