宏基因组学第二代测序对肺部感染的临床指导价值

Clinical guiding value of metagenomics second-generation sequencing for pulmonary infection

目的探讨宏基因组学第二代测序(mNGS)对肺部感染的临床指导意义。方法收集43例住院肺部感染患者的临床数据,均采用mNGS技术和传统病原学检测技术进行病原体检测,评价mNGS技术在微生物病原体种类数、灵敏度、检测时长方面的优势。结果mNGS在微生物总的检出种类数量明显高于传统检测技术,差异有统计学意义(χ^(2)=7.85,P<0.05)。43例患者通过mNGS技术检测,28例检测出病原体并判读为致病原,灵敏度为65.12%,包括非重症患者18例,灵敏度为64.29%;重症患者10例,灵敏度为66.67%。通过传统检测技术检测出16例,灵敏度为37.21%;包括非重症患者9例,灵敏度32.14%;重症组7例,灵敏度46.67%。mNGS检测总灵敏度、非重症患者和重症患者的灵敏度均明显高于传统检测技术,差异均有统计学意义(χ^(2)分别=9.65、9.72、6.18,P均<0.05)。mNGS检测时间平均为(2.31±0.62)d,传统检测技术平均为(3.84±0.93)d,mNGS检测用时明显少于传统检测技术,差异有统计学意义(t=4.29,P均<0.05)。结论mNGS技术在检测微生物病原体种类数、灵敏度、检测时长方面均优于传统成熟技术,结合临床表现调整治疗方案患者可以明显受益。

Objective To explore the clinical guiding significance of metagenomics second-generation sequencing(mNGS)for pulmonary infection.Methods The clinical data of 43 hospitalized patients with pulmonary infection were collected.mNGS and traditional etiological detection techniques were used to detect pathogens,and to evaluate the advantages of mNGS in the number of microbial pathogens,sensitivity and detection time.Results The total number of detected species of mNGS in microorganisms was significantly higher than that of traditional detection techniques,and the difference was statistically significant(χ^(2)=7.85,P<0.05).There are 43 cases were detected by mNGS technology,28 cases were detected and interpreted as pathogens,the sensitivity was 65.12%,including 18 non-severe patients,the sensitivity was 64.29%,and 10 severe patients,the sensitivity was 66.67%.Through traditional detection technology,16 cases were deteded and interpreted as pathogens,the sensitivity was 37.21%,including 9 cases of non-severe patients,the sensitivity was 32.14%,and 7 severe patients,the sensitivity was 46.67%.The total sensitivity of mNGS and the sensitivity of non-severe patients and severe patients were significantly higher than those of traditional detection techniques(χ^(2)=9.65,9.72,6.18,P<0.05).The average detection time for mNGS was(2.31±0.62)days,and traditional detection techniques was(3.84±0.93)days.The time used for mNGS detection was significantly lesser than that of traditional detection techniques,and the difference was statistically significant(t=4.29,P<0.05).Conclusion mNGS technology in the detection of microbial pathogens species number,sensitivity and the detection time are superior to traditional mature technology,combined with clinical manifestation for treatment.