外周血宏基因组二代测序技术在血液病合并发热患者中的临床应用价值

Clinical application value of peripheral blood metagenomic next-generation sequencing test for patients with hematological diseases accompanied by fever

目的探讨外周血宏基因组二代测序技术(mNGS)在血液病合并发热患者中的临床应用价值。方法回顾性分析2020年3月至2021年6月在天津医科大学总医院血液科住院治疗的血液病合并发热并进行外周血mNGS检测的90例患者共98份标本的mNGS结果及临床资料, 分析病原分布特征与血mNGS的检验效能。结果外周血mNGS阳性率为68.37%(67/98), 明显高于传统检查(37.76%, P<0.001)与血培养(9.18%, P<0.001)。单纯检出病毒、细菌、真菌阳性样本分别占38.81%、14.93%、2.99%;混合感染占43.28%, 其中以病毒和细菌混合型最为多见(25.37%);病毒阳性55例次(82.09%), 细菌阳性30例次(44.78%), 真菌阳性14例次(20.90%)。外周血mNGS与传统检查的临床认可率为64.63%(63/98);以传统检查结果作为参照标准, 外周血mNGS敏感性、特异性、阳性预测值(PPV)和阴性预测值(NPV)分别为75.68%、36.07%、41.79%和70.97%, 整体一致率为51.02%。传统检查阴性的22例次肺部感染, 有14例次外周血mNGS检出病原, 其中10例次为临床认可。结论该组血液病合并发热患者外周血mNGS病毒检出率高、混合感染比例高;外周血mNGS阳性率明显高于血培养以及传统实验室检查;外周血mNGS在血液病合并发热患者病原检出方面具有较高的临床认可率、敏感性及阴性预测值。

Objective To investigate the clinical application value of peripheral blood metagenomic next-generation sequencing(mNGS)test for patients with hematological diseases accompanied by fever.Methods The blood mNGS results and clinical data of inpatients with hematological diseases accompanied by fever treated in the Hematology Department of Tianjin Medical University General Hospital in March 2020 to June 2021were retrospectively analyzed.A total of 90 patients with 98 cases of specimens were included.The pathogen distribution characteristics and mNGS test performance were analyzed.Results The positive rate of peripheral blood mNGS was significantly higher than that of traditional examination(68.37%vs 37.76%,P<0.001)and blood culture(68.37%vs 9.18%,P<0.001).Viral,bacterial,and fungal infections accounted for 38.81%,14.93%,and 2.99%in patients with single-pathogen infections,respectively.Polymicrobial infections accounted for 43.28%,in which viral and bacterial coinfections were the most common type(25.37%).There were 55 virus-positive cases(82.09%),30 bacteria-positive cases(44.78%),and 14 fungus-positive cases(20.90%).The clinical approval rate of peripheral blood mNGS was 64.63%(63/98).The sensitivity,specificity,positive predictive value,and negative predictive value(NPV)of peripheral blood mNGS were 75.68%,36.07%,41.79%,and 70.97%,respectively,and the overall consistency rate with traditional examination was 51.02%.Of the 22 pulmonary infection cases with no detectable pathogens by conventional tests,the pathogens were identified by peripheral blood mNGS in 14 cases,10 of which were clinically approved.Conclusion The positive rate of peripheral blood mNGS was significantly higher than that of blood culture and traditional laboratory examination.Peripheral blood mNGS had a high clinical recognition rate,sensitivity,and NPV in the detection of pathogens in patients with hematological diseases accompanied by fever.