宏基因组测序技术在儿童中枢神经系统感染性疾病中的临床价值分析

Analysis of clinical value of metagenomic next generation sequencing in children with infectious diseases of central nervous system

目的了解宏基因组测序技术(metagenomic next generation sequencing,mNGS)和传统细菌培养联合荧光定量PCR(qPCR)两种检测方法在儿童中枢神经系统(central nervous system,CNS)感染性疾病诊治方面的指导意义。方法收集2019年4月至2020年1月考虑CNS感染性疾病的55例患儿为观察组,进行脑脊液mNGS检测,2018年5月至2019年4月疑似CNS感染并进行了脑脊液常规培养和qPCR检测的51例患儿为对照组。观察组年龄5个月~9岁,对照组年龄1个月~11岁。对比两组病原检测阳性率和住院时间。结果观察组中24例患儿脑脊液标本的高通量测序结果为阳性,灵敏度为43.6%,其中11例(20.0%)检测为细菌,2例(3.6%)检测为真菌,9例(16.4%)检测为病毒,2例(3.6%)检测为分枝杆菌;在总阳性率上高于对照组,差异有统计学意义(P<0.05)。观察组患儿住院时间为(17.19±13.3)d,对照组患儿住院时间为(24.90±14.8)d,差异有统计学意义(t=2.825,P=0.006)。结论mNGS在脑脊液病原菌检测方面优于传统细菌培养联合qPCR,可以缩短CNS感染性疾病患儿的住院时间。

Objective To investigate the clinical significance of metagenomic next generation sequencing(mNGS)and traditional quantitative real-time polymerase chain reaction(qPCR)in children with infectious diseases of central nervous system(CNS).Methods We retrospectively collected 55 children who were suspected with CNS infection between April 2019 and January 2020 as an observation group,who underwent the mNGS test of the cerebrospinal fluid.Fifty-one children with suspected CNS infection who underwent routine culture of the cerebrospinal fluid and qPCR testing between May 2018 and April 2019 were selected as a control group.The age of children in the observation group was 5 months-9 years old,and the age of children in the control group was 1 month-11 years old.The positive detection rate of pathogen and length of hospital stay were compared between the two groups.Results In the observation group,mNGS of cerebrospinal fluid samples from 24 children was positive,with the sensitivity of 43.6%.Among them,there were 11 cases(20.0%)of bacterial infection,2 cases(3.6%)of fungal infection,9 cases(16.4%)of virus infection,and 2 cases(3.6%)of mycobacterium infection.The total positive rate in the observation group was higher than that in the control group,with a statistically significant difference(P<0.05).The length of hospital stay in the observation group was(17.19±13.3)d,and that in the control group was(24.90±14.8)d,with a statistically significant difference(t=2.825,P=0.006).Conclusion mNGS is superior to the traditional bacterial culture combined with qPCR in the detection of pathogens of cerebrospinal fluid,which can shorten the hospitalization time of children with CNS infectious diseases.