宏基因组二代测序技术在儿童泌尿道感染患者中的临床应用  

Clinical application of metagenomic next-generation sequencing technology in pediatric urinary tract infections

作　　者：孙金山[1] 陈朝英[1] 涂娟[1] 耿海云[1] 李华荣[1] 万灵 王弘扬 Sun Jinshan;Chen Chaoying;Tu Juan;Geng Haiyun;Li Huarong;Wan Ling;Wang Hongyang(Department of Nephrology,Children's Hospital,Capital Institute of Pediatrics,Bejing 100020,China;Department of Urology,Children's Hospital,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院肾脏内科,北京100020 [2]首都儿科研究所附属儿童医院泌尿外科,北京100020

出　　处：《中华实用儿科临床杂志》2025年第4期268-272,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：首都儿科研究所青年基金项目(QN-2024-21)。

摘　　要：目的探讨宏基因组二代测序(mNGS)技术在儿童泌尿道感染(UTI)病原菌的诊断价值和临床应用。方法回顾性研究。收集2023年3月至2024年3月于首都儿科研究所附属儿童医院肾脏内科住院诊断为UTI患儿的临床资料,比较mNGS技术与尿培养病原菌检出阳性率、时效性和一致性。组间比较采用独立样本t检验及χ^(2)检验或Fisher′s精确概率检验。结果共纳入193例患儿,尿培养检出阳性率为70/193(36.3%),对42例进行mNGS检测的患儿中检出阳性菌者37例(88.1%),mNGS检查阳性率显著高于尿培养检查,差异有统计学意义(χ^(2)=37.357,P<0.001)。同时mNGS报告时间显著低于尿培养报告时间(Z=3.524,P<0.001)。在42例进行mNGS检测的病例中2种方法检测尿液病原菌均阴性5例(11.9%),有21例(50.0%)mNGS检测结果阳性而尿培养结果阴性,余16例(38.1%)mNGS和尿培养结果均阳性的病例中,完全匹配14例(33.3%),完全不匹配1例(2.4%),1例(2.4%)部分匹配。比较尿培养和mNGS检测阳性率与留取标本前抗感染治疗时间,经统计分析发现尿培养阳性中位数持续时间为5d,而mNGS检测阳性中位数持续时间为20d,差异有统计学意义(χ^(2)=0.537,P<0.001)。结论mNGS检测技术对于儿童UTI病原菌的诊断有较高的敏感性,和尿培养相比具有良好的一致性,并大大缩短检出时间,且检出阳性率不易受抗菌治疗影响,对于儿童UTI尤其是经验性抗感染治疗失败、尿培养检查无法明确致病菌的患儿建议尽早完善mNGS检查。Objective:To explore the diagnostic value and clinical application of metagenomic next-generation sequencing(mNGS)technology in pediatric urinary tract infections(UTI).Methods:In this retrospective study,the clinical data of children with UTI admitted to the Department of Nephrology,Children′s Hospital,Capital Institute of Pediatrics,from March 2023 to March 2024 were collected.The positive detection rates,timeliness,and consistency of mNGS technology were compared with those of urine culture.Measurement data were subject to test of normality.The independent sample t test,Chi-square test or Fisher′s exact probability test were used for comparison between groups.Results:A total of 193 patients were included.The positive detection rate of urine culture was 36.3%(70/193).Among 42 patients who underwent mNGS testing,37 cases(88.1%)tested positive.The positive detection rate of mNGS was significantly higher than that of urine culture(χ^(2)=37.357,P<0.001).It took significantly less time to report mNGS results than to report urine culture results(Z=3.524,P<0.001).In the 42 cases that underwent mNGS testing,5 cases(11.9%)were negative for urine pathogens by both methods,and 21 cases(50.0%)were positive by mNGS but negative by urine culture.Among the remaining 16 cases(38.1%)positive by both mNGS and urine culture,14 cases(33.3%)achieved fully matching results,1 case(2.4%)was fully mismatched,and 1 case(2.4%)was partially matched.Comparison of the positive detection rate and the duration of anti-infective treatment prior to specimen collection between urine culture and mNGS showed that the median durations for urine culture and mNGS positivity were 5 and 20 days,and the difference was statistically significant(χ^(2)=0.537,P<0.001).Conclusions:mNGS technology has high sensitivity for diagnosing pathogens in pediatric UTI.Compared with urine culture,mNGS provides good consistency and significantly shortens the detection time.The positive detection rate is less affected by antimicrobial treatment.For children with UTI

关 键 词：儿童 宏基因组二代测序 泌尿道感染 

分 类 号：R726.9[医药卫生—儿科]