经脑脊液病原体高通量测序技术诊断中枢神经系统感染性疾病的价值  

Exploring the value of high throughput sequencing technology for diagnosing infectious diseases in the cen-tral nervous system through cerebrospinal fluid pathogens

作　　者：马国梅 李辉 王亚丽 曹端华 韩敬哲 MA Guomei;LI Hui;WANG Yali;CAO Duanhua;HAN Jingzhe(Department of Neurology,Hengshui People′s Hospital,Hengshui 053000,Hebei,China)

机构地区：[1]衡水市人民医院神经内科,衡水053000

出　　处：《医学研究与战创伤救治》2025年第2期170-173,共4页Journal of Medical Research & Combat Trauma Care

基　　金：河北省重点研发计划项目(22006321882D);衡水市科技计划项目(2019014078Z)。

摘　　要：目的探究经脑脊液病原体高通量测序技术(NGS)诊断中枢神经系统感染(ICNS)的价值。方法选取2020年3月至2022年1月衡水市人民医院95例经脑脊液病原体培养或PCR测定病原体DNA确诊的ICNS患者。均行脑脊液病原体NGS检测,以经脑脊液病原体培养或PCR测定病原体DNA结果为“金标准”,分析脑脊液病原体NGS诊断不同类型ICNS的诊断效能,并比较不同类型ICNS患者临床症状、脑脊液生化结果。结果NGS检查显示,病毒性脑炎43例,化脓性脑膜炎27例,结核性脑膜炎42例,隐球菌性脑膜炎20例。结核性脑膜炎、隐球菌性脑膜炎脑膜刺激征阳性率高于病毒性脑炎(P<0.05);脑脊液病原体NGS诊断病毒性脑炎、化脓性脑膜炎、结核性脑膜炎、隐球菌性脑膜炎的特异度、准确度、阳性预测值、阴性预测值比较差异有统计学意义(P<0.05),其中诊断化脓性脑膜炎、隐球菌性脑膜炎的特异度、准确度高于诊断病毒性脑炎、结核性脑膜炎的特异度、准确度(P<0.05)。结论经脑脊液病原体NGS可用于ICNS早期鉴别诊断中,临床可结合脑脊液生化指标辅助评估ICNS类型,为临床针对性制定干预措施提供了依据。Objective To explore the value of high throughput sequencing technology(NGS)for diagnosing central nervous system infection(ICNS)through cerebrospinal fluid pathogens.Methods Ninety five patients with ICNS diagnosed by cerebrospinal fluid pathogen culture or PCR detection of pathogen DNA in our hospital from March 2020 to January 2022 were selected,all of whom underwent cerebrospinal fluid pathogen NGS testing.The results of cerebrospinal fluid pathogen culture or PCR detection of pathogen DNA were used as the"gold standard"for statistical analysis of the diagnostic efficacy of cerebrospinal fluid pathogen NGS in diagnosing different types of ICNS,and the clinical symptoms and cerebrospinal fluid biochemistry of patients with different types of ICNS were compared.Results The results of NGS examination were as follows:43 cases of viral encephalitis,27 cases of purulent meningitis,42 cases of tuberculous meningitis,and 20 cases of cryptococcal meningitis;the positive rate of meningeal irritation signs in tuberculous meningitis and cryptococcal meningitis was higher than that in viral encephalitis(P<0.05);there were significant differences(P<0.05)in specificity,accuracy,positive predictive value,and negative predictive value of NGS diagnosis of viral encephalitis,purulent meningitis,tuberculous meningitis,and cryptococcal meningitis.The specificity and accuracy of purulent meningitis and cryptococcal meningitis were higher than those of viral encephalitis and tuberculous meningitis(P<0.05).Conclusion The NGS of cerebrospinal fluid pathogens can be used in the early differential diagnosis of ICNS.The clinical evaluation of ICNS types can be assisted by combining cerebrospinal fluid biochemical indicators,providing a basis for the development of targeted clinical interventions to improve prognosis.

关 键 词：脑脊液病原体 中枢神经系统感染 脑脊液生化指标 高通量测序 诊断价值 

分 类 号：R741[医药卫生—神经病学与精神病学]