宏基因组下一代测序在ICU不同病原菌血流感染早期诊断中的应用  

Application of metagenomic next-generation sequencing in early diagnosis of bloodstream infection caused by different pathogenic bacteria in ICU

作　　者：黄中坚 周观娇 吴庆梅 陈建欢 邓泽群 林杰 覃钦 刘端绘 HUANG Zhongjian;ZHOU Guanjiao;WU Qingmei;CHEN Jianhuan;DENG Zequn;LIN Jie;QIN Qin;LIU Duanhui(Wuzhou Gongren Hospital,Wuzhou 543001;Wuzhou Red Cross Hospital,Wuzhou 543002,China)

机构地区：[1]梧州市工人医院,广西梧州543001 [2]梧州市红十字会医院,广西梧州543002

出　　处：《临床医学研究与实践》2025年第7期106-109,共4页Clinical Research and Practice

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题项目(No.Z-D20221718);梧州市科技计划项目(No.202102075)。

摘　　要：目的探究宏基因组下一代测序(mNGS)在ICU不同病原菌血流感染(BSI)早期诊断中的临床应用价值。方法选取2022年1月至2023年11月梧州市工人医院ICU收治的60例BSI患者作为研究对象,所有患者均进行血培养和mNGS。比较血培养和mNGS的病原菌检测结果;分析mNGS的阳性检出率及诊断效能;比较mNGS阳性和阴性患者的白细胞计数(WBC)、中性粒细胞比例(NEU%)、降钙素原(PCT)及C反应蛋白(CRP)水平。结果mNGS的检测时长短于血培养,病原菌检出率高于血培养(P<0.05)。血培养检出细菌13种,真菌4种;mNGS检出细菌29种,病毒7种,真菌8种,其中细菌种类以鲍曼不动杆菌为主,病毒以人单纯疱疹病毒1型为主,真菌以白色念珠菌为主。mNGS的阳性检出率为53.33%,灵敏度为96.88%,特异度为96.43%,准确度为96.67%。mNGS阳性患者的WBC、NEU%、PCT及CRP水平高于mNGS阴性患者(P<0.05)。结论mNGS在ICU不同病原菌BSI早期诊断中展现出高病原菌检出率、检测时长短、高灵敏度、高特异度的特点,且其阳性结果与炎性指标水平升高显著相关,有助于BSI的早期精准诊断,值得推广。Objective To explore the clinical application value of metagenomic next-generation sequencing(mNGS)in early diagnosis of bloodstream infection(BSI)caused by different pathogenic bacteria in ICU.Methods Sixty patients with BSI admitted in the ICU of Wuzhou Gongren Hospital from January 2022 to November 2023 were selected as the study subjects.All patients underwent blood culture and mNGS.The detection results of pathogenic bacteria by blood culture and mNGS was compared;the positive detection rate and diagnostic efficacy of mNGS were analyzed;the white blood cell count(WBC),neutrophil ratio(NEU%),procalcitonin(PCT)and C-reactive protein(CRP)levels were compared between the mNGS positive and negative patients.Results The detection time of mNGS was shorter than that of blood culture,and the detection rate of pathogenic bacteria was higher than that of blood culture(P<0.05).A total of 13 kinds of bacteria and 4 kinds of fungi were detected by blood culture;29 kinds of bacteria,7 kinds of viruses and 8 kinds of fungi were detected by mNGS,Among them,Acinetobacter baumannii was the main bacterial species,human herpes simplex virus type 1 was the main virus,and Candida albicans was the main fungi.The positive detection rate of mNGS was 53.33%,the sensitivity was 96.88%,the specificity was 96.43%,and the accuracy was 96.67%.The WBC,NEU%,PCT and CRP levels in the mNGS positive patients were higher than those in the mNGS negative patients(P<0.05).Conclusion mNGS shows the characteristics of high pathogen detection rate,short detection time,high sensitivity and high specificity in the early diagnosis of BSI caused by different pathogenic bacteria in ICU,and its positive results are significantly correlated with the increase of inflammatory indexes levels,which is helpful for the early accurate diagnosis of BSI and is worthy of clinical promotion.

关 键 词：宏基因组下一代测序 血流感染 病原菌 炎性指标 

分 类 号：R378[医药卫生—病原生物学]