不同方法在中枢神经系统感染病原学诊断中的价值

Value of different methods in pathogenic diagnosis of central nervous system infection

目的探讨自动化核酸快速检测设备FilmArray meningitis/encephalitis(FA ME)panel、宏基因组第二代测序(mNGS)在中枢神经系统(CNS)感染病原学诊断中的价值。方法收集2020年6月—2021年1月中山大学附属第三医院收治的29例疑似CNS感染患者脑脊液标本,进行FA ME检测及mNGS,结合细菌/真菌培养,以及病毒核酸/血清学结果,比较FA ME、mNGS在CNS感染病原学诊断中的效果。结果FA ME、mNGS细菌阳性率分别为7.1%、9.1%,数值略高于细菌培养3.4%,差异无统计学意义(P=1.000)。真菌方面,FA ME、mNGS阳性率分别为10.7%、13.6%,均低于真菌培养(17.2%),差异具有统计学意义(P=0.003)。FA ME、mNGS检测病毒的阳性率分别为3.6%、18.2%,高于院内病毒核酸/血清学检测(0)。结论FA ME、mNGS目前不足以代替院内常规检测,但可作为传统检测的补充手段提高CNS感染病原体检出水平。

Objective To explore the value of FilmArray meningitis/encephalitis(FA ME) panel and metageno-mics next-generation sequencing(mNGS) in pathogenic diagnosis of central nervous system(CNS) infection. Methods Cerebrospinal fluid(CSF) specimens from 29 patients with suspected CNS infection in the Third Affiliated Hospital of Sun Yat-sen University between June 2020 and January 2021 were collected for FA ME panel detection and mNGS, combined with bacterial/fungal culture and viral nucleic acid/serological detection results, effects of FA ME and mNGS in the pathogenic diagnosis of CNS infection were compared. Results The positive rates of FA ME and mNGS were 7.1% and 9.1% respectively, which were slightly higher than 3.4% of bacterial culture, there was no significant difference(P=1.000). In terms of fungi, positive rates of FA ME and mNGS were 10.7% and 13.6% respectively, which were both lower than those in fungal culture(17.2%), difference was significant(P=0.003). The positive rates of virus detected by FA ME and mNGS were 3.6% and 18.2% respectively, which were higher than those detected by nucleic acid/serology in hospital(0). Conclusion FA ME and mNGS are not enough to replace the current routine detection in hospital, but may be used as an adjunctive tool to improve the detection level of CNS infection pathogens.