宏基因组二代测序在血液系统疾病合并感染中的应用价值  

Application Value of Metagenomic Next Generation Sequencing in Hematological Diseases Complicated with Infection

作　　者：高静 郝淼旺 及月茹 严学倩 陈怡 肖方 李瑗春 GAO Jing;HAO Miaowang;JI Yueru;YAN Xueqian;CHEN Yi;XIAO Fang;LI Yuanchun(Department of Hematology,Second Affiliated Hospital of Air Force Military Medical University,Xi'an 710038,China)

机构地区：[1]空军军医大学第二附属医院血液内科,陕西西安710038

出　　处：《药物生物技术》2025年第1期44-49,共6页Pharmaceutical Biotechnology

基　　金：陕西省自然科学基金项目(No.2020JQ-460)。

摘　　要：研究宏基因组二代测序(mNGS)技术在血液系统疾病合并感染中病原学诊断的价值。收集2021年1月至2022年6月空军军医大学第二附属医院血液内科收治的135例血液系统疾病合并感染患者临床基本资料,同时采集患者的标本(包括外周血、痰液、肺泡灌洗液及其他体液)同步进行mNGS和常规微生物培养,比较两者的检验效能。本次研究对象中,男性84例,女性51例,中位年龄为53岁,平均年龄(49.1±18.1)岁;疾病分布为急性白血病66例,非霍奇金淋巴瘤32例,多发性骨髓瘤13例,再生障碍性贫血9例,其他疾病15例。合并化疗110例,合并粒细胞缺乏症112例,合并骨髓移植26例,共取材标本为135份同时送检。mNGS检测病原体阳性率为74.81%,常规检测阳性率为39.26%,差异具有统计学意义(P<0.01);mNGS诊断混合感染的阳性率为57.43%,常规检测为15.09%,差异具有统计学意义(χ^(2)=25.434,P<0.01);mNGS检测外周血阳性率为70.42%(50/71),肺泡灌洗液阳性率87.18%(34/39),痰液阳性率68.75%(11/16),其他体液阳性率66.67%(6/9),根据χ^(2)检验结果,肺泡灌洗液检测阳性率高于外周血检测,且两者比较有统计学意义(χ^(2)=3.916,P=0.048),其他样本比较P>0.05,阳性率之间无明显统计学意义;mNGS诊断混合感染的阳性率比常规微生物培养方法更高(57.43%vs 15.09%),差异具有统计学意义(χ^(2)=25.434,P<0.01);mNGS检测灵敏度为90.57%,特异性35.37%。mNGS在血液系统疾病合并感染的病原学诊断中具有重要的临床价值和良好的应用前景。To study the value of metagenomic next-generation sequencing(mNGS)technology in the etiological diagnosis of hematological diseases complicated with infections,the clinical basic data of 135 patients with hematological diseases complicated with infections admitted to the Second Affiliated Hospital of Air Force Military Medical University from January 2021 to June 2022 were collected,and the specimens(including peripheral blood,sputum,alveolar lavage fluid and other body fluids)were collected for simultaneous mNGS and conventional microbial culture to compare the testing efficacy of the two methods.Among the subjects in this study,there were 84 males and 51 females,with a median age of 53 years and an average age of(49.1±18.1)years.The disease distribution was acute leukemia in 66 cases,non-Hodgkin lymphoma in 32 cases,multiple myeloma in 13 cases,aplastic anemia in 9 cases,and other diseases in 15 cases.There were 110 cases with chemotherapy,112 cases with granulocytopenia,and 26 cases with bone marrow transplantation.A total of 135 specimens were collected and tested at the same time.The positive rate of pathogens detected by mNGS was 74.81%,and the positive rate of conventional detection was 39.26%,with a statistically significant diffe-rence(P<0.01).The positive rate of mNGS diagnosis of mixed infections was 57.43%,and the positive rate of conventional detection was 15.09%,with a statistically significant difference(χ^(2)=25.434,P<0.01).The positive rate of mNGS detection in peripheral blood was 70.42%(50/71),in BALF 87.18%(34/39),in sputum 68.75%(11/16),and in other body fluids 66.67%(6/9).According to the results ofχ^(2)test,the positive rate of BALF detection was higher than that of peripheral blood detection,and the difference was statistically significant(χ^(2)=3.916,P=0.048).The positive rate of mNGS diagnosis of mixed infection was higher than that of conventional microbial culture(57.43%vs 15.09%),and the difference was statistically significant(χ^(2)=25.434,P<0.01).The sensitivity of mNGS detecti

关 键 词：宏基因组二代测序 血液系统疾病 单一感染 混合感染 细菌 真菌 病毒 

分 类 号：R552[医药卫生—血液循环系统疾病]