109例发热待查病原谱分析及宏基因二代测序的应用价值  

Analysis of pathogen spectrum in 109 cases of fever of unknown origin and application value of metagenomic next-generation sequencing

作　　者：李慧茹 张慧[1] 叶英[1] Li Huiru;Zhang Hui;Ye Ying(Department of nosocomial infection disease,the first affiliated hospital of Anhui Medical University,Hefei,Anhui,230022,China)

机构地区：[1]安徽医科大学第一附属医院感染病科,安徽合肥230022

出　　处：《齐齐哈尔医学院学报》2025年第8期701-706,共6页Journal of Qiqihar Medical University

基　　金：国家自然科学基金(No.82304209)。

摘　　要：目的分析109例发热待查患者临床特征,对比微生物宏基因二代测序(mNGS)与传统检测方法的检出效能,为临床诊疗提供参考。方法回顾性分析2022年1-6月本院收治的符合经典型发热待查诊断标准的109例患者的临床资料,分析病因及临床特征,对比mNGS与传统检测方法的检出效能。结果感染性疾病71例(65.14%),非感染性疾病26例(23.85%),病因未明疾病12例(11.01%)。感染性疾病中细菌感染最多见(74.65%),确诊时间2周以内占比84.51%,延后诊断主要因为混合感染、复数菌感染等。感染性疾病组男性较为年轻,非感染性炎症性疾病组及其他疾病组热峰集中于高热阶段,病因未明疾病组热程均超过4周。感染组白细胞增高及正常比例高达95.77%(68/71)。白细胞正常和减少比例,在非感染性疾病组占比57.7%(15/26),在病因未明组占比83.3%(10/12)。PET/CT对非感染性疾病诊断有重要意义。mNGS在病原体检出方面较传统病原体检测方法具有优势(78.69%VS34.43%,P<0.001),在临床诊断的一致性上也优于传统检测方法(χ^(2)=7.130,P=0.008)。结论发热待查病因复杂,需结合病因谱、临床特征、实验室及影像学检查,进行综合分析。感染性疾病在病因中仍占首位,mNGS在病原体检出及临床一致性方面较传统检测方法具有优势,值得推广应用。Objective To analyze the clinical characteristics of 109 patients with fever to be investigated,and to compare the detection efficacy of microbial metagenomic next-generation sequencing(mNGS)with that of traditional detection methods,in order to provide reference for clinical diagnosis and treatment.Methods 109 patients who met the diagnostic criteria of classic fever pending investigation in the First Affiliated Hospital to Anhui Medical University from January 1,2022 to June 30,2022 were collected,and the etiology and clinical characteristics were retrospectively analyzed to compare the detection efficacy of mNGS with that of the traditional detection methods.Results There were 71 cases(65.14%)of infectious diseases,26 cases(23.85%)of non-infectious diseases,and 12 cases(11.01%)of diseases of undetermined etiology.Bacterial infections were most common in infectious diseases(74.65%),and the time to diagnosis was less than 2 weeks in 84.51%of cases,and delayed diagnosis was mainly due to mixed infections and plural bacterial infections.Males were younger in the infectious disease group,fever peaks were concentrated in the hyperthermia stage in the non-infectious inflammatory disease group and other disease groups,and the duration of fever was more than 4 weeks in the group of diseases of undetermined etiology.The proportion of increased and normal leukocytes in the infectious group was as high as 95.77%(68/71).The proportion of normal and decreased leukocytes was 57.7%(15/26)in the non-infectious disease group and 83.3%(10/12)in the etiology-unknown disease group.PET/CT is important for the diagnosis of non-infectious diseases.mNGS had an advantage over the traditional pathogen detection methods in terms of pathogen detection(78.69%vs.34.43%,P<0.001),and was also superior to traditional methods in terms of clinical consistency of diagnosis was also superior to traditional testing methods(χ^(2)=7.13,P=0.008).Conclusions The etiology of fever to be investigated is complex and needs to be analyzed comprehensively b

关 键 词：发热待查 感染性疾病 非感染性疾病 宏基因二代测序 

分 类 号：R446.5[医药卫生—诊断学]