宏基因组二代测序在感染性胰腺坏死病原学诊断中应用研究

The preliminary clinical use of metagenomic next-generation sequencing in infected pancreatic necrosis

目的研究宏基因组二代测序(mNGS)技术在感染性胰腺坏死(IPN)病原学诊断中的价值。方法前瞻性收集2019年8月至2020年6月间中南大学湘雅医院胰腺外科连续收治的18例怀疑感染的急性坏死性胰腺炎(ANP)病例,同时采血进行m NGS和常规微生物培养,对比这2种病原学检测方法的检验效能。结果全组病死率为16.7%(3/18)。住院期间确诊IPN 11例(11/18,61.1%)。血mNGS诊断IPN的灵敏度高于血培养,差异具有统计学意义(100.0%vs.9.0%,P=0.003),而两者的特异度差异无统计学意义(71.4%vs.57.1%,P>0.1)。血mNGS平均检测耗时较血培养明显缩短,差异有统计学意义[(37.70±1.44)h vs.(115.23±8.79)h,P<0.01]。血mNGS检测费用仅占平均住院总费用的1.3%。结论mNGS在IPN的早期病原学诊断中具有重要价值,且耗时较短,性价比高,具有良好的应用前景。

Objective To investigate the clinical value of metagenomic next-generation sequencing(mNGS)in the early diagnosis of microbiology of infected pancreatic necrosis(IPN).Methods A total of 18 suspected cases of IPN were enrolled prospectively at the Department of Pancreatic Surgery,Xiangya Hospital,Central South University from August 2019 to June 2020.Blood samples were collected simultaneously for mNGS and microbial culture during fever(T≥38.5℃).The diagnostic performance of the two methods were compared.Results The mortality rate was 16.7%(3/18).Eleven patients(61.1%)were confirmed to have IPN during hospitalization.The sensitivity of blood mNGS was significantly higher than blood culture(100.0%vs.9.0%,P=0.003),whereas no significant difference was found in terms of specificity(71.4%vs.57.1%,P>0.1).The turnaround time of mNGS was significantly shorter than that of microbial culture[(37.70±1.44)h vs.(115.2.3±8.79)h,P<0.01].The average costs of mNGS accounted for 1.3%of the average total cost of hospitalization.Conclusion With valuable diagnostic performance,shorter turnaround time and higher cost performance,mNGS might play important role in the early diagnosis of IPN.