mNGS技术在儿童重症肺炎病原学诊断中的价值

The value of mNGS technology in the etiological diagnosis of severe pneumonia in children

目的探讨宏基因组二代测序(mNGS)技术在儿童重症肺炎病原学诊断中的价值。方法选取2017年12月至2020年6月武汉儿童医院收治住院治疗的219例社区获得性重症肺炎患儿临床资料,比较肺泡灌洗液mNGS检测与传统实验室病原检测对诊断儿童重症肺炎的诊断价值。结果 219例送检标本中mNGS共检出阳性病例190例(86.76%);而传统实验室病原共检出阳性病例173例(78.99%),两种检测方法比较,差异有统计学意义(P<0.05)。mNGS和传统实验室病原病原总检出率在各年龄段之间比较,差异有统计学意义(Χ^(2)=76.488 7,P<0.05)。mNGS与传统实验室病原学检测均阳性患者163例,mNGS与传统实验室病原学检测均阴性患者22例,mNGS阳性而传统实验室病原学检测阴性患者27例,mNGS阴性而传统实验室病原学检测阳性患者7例。mNGS和传统实验室病原诊断儿童重症肺炎病原学灵敏度、特异度比较,差异有统计学意义(P<0.05)。结论二代测序技术较传统实验室病原检测可快速检测重症肺炎患儿病原学诊断,指导临床早期合理用药。

Objective To explore the value of metagenomic next generation sequencing(m NGS)in the etiological diagnosis of severe pneumonia in children. Methods The clinical data of 219 children with community-acquired severe pneumonia hospitalized in Wuhan Children’s Hospital from December 2017 to June 2020 were selected. The diagnostic value of m NGS detection between alveolar lavage fluid and traditional laboratory pathogen detection in the diagnosis of severe pneumonia in children was compared. Results Among the 219 specimens submitted for inspection,190 positive cases(86.76%)were detected by m NGS detection,and 173 positive cases(78.99%)were detected by traditional laboratory pathogens. The difference between the two detection methods was statistically significant(P<0.05). The differences in the total pathogen detection rate of every age bracket were significant between the m NGS and traditional laboratory pathogens detection(χ^(2)=76.4887,P<0.05). 63 patients were positive in both the m NGS and traditional laboratory pathogenic detection,22 were negative in the m NGS and traditional laboratory pathogenic detection. 27 patients were positive in the m NGS detection but negative in the traditional laboratory pathogenic detection,and 7 patients were negative in the m NGS but positive in the traditional laboratory pathogen detection. The sensitivity and specificity between the m NGS and traditional laboratory pathogens in the diagnosis of severe pneumonia in children were compared,the differences were statistically significant(P<0.05). Conclusions Compared with the traditional laboratory pathogen detection,the metagenomic next generation sequencing can quickly detect the pathogenic diagnosis of children with severe pneumonia and guide the rational use of drugs in the early clinical stage.