感染性心内膜炎瓣膜mNGS检测的病原学价值

Pathogenic value of mNGS in detecting valves of patients with infective endocarditis

目的评估瓣膜宏基因组二代测序(metagenomic next generationsequencing,mNGS)对感染性心内膜炎(infective endocarditis,IE)的病原学诊断价值。方法收集于2022年6月1日至11月30日在南京医科大学附属南京医院接受瓣膜手术患者25例,根据改良杜克标准确诊为IE患者20例,非IE患者5例。采集各患者的静脉血及瓣膜组织标本,同时进行血培养、瓣膜培养以及瓣膜mNGS检测,并进一步比较mNGS和传统诊断方法(血培养、瓣膜培养)诊断IE病原学的临床效能。结果在20例经病理诊断为IE的患者中,血培养阳性8例,瓣膜培养阳性3例,瓣膜mNGS阳性19例;血培养、瓣膜培养和瓣膜mNGS诊断IE的敏感性分别为40%、15%和95%。瓣膜mNGS与血培养或瓣膜培养的检测结果在细菌的属水平上相一致。瓣膜mNGS的属相对丰度(P=0.001)、种序列数(P=0.028)、覆盖率(P=0.003)与抗生素的使用时间有关。瓣膜mNGS可以指导培养阴性IE患者的抗生素治疗。结论瓣膜mNGS对IE的病原学诊断具有较高的临床价值,为后续患者的抗生素治疗提供了依据。

Objective To evaluate the value of valve metagenomic next-generation sequencing(mNGS)in the pathogenic diagnosis of infective endocarditis(IE).Methods A total of 25 patients who underwent valve surgery in our hospital between June 1,2022 and November 30,2022 were enrolled in the study.According to the modified Duke criteria,20 patients were diagnosed as IE patients and 5 patients were non-IE patients.The venous blood and valve tissue samples from each patient were collected,and blood culture,valve culture and mNGS were performed.The clinical efficacy of mNGS and traditional diagnostic methods such as blood culture and valve culture in diagnosing the etiology of IE was compared.Results Among the 20 patients diagnosed with IE by pathology,8 were positive for blood culture,3 were positive for valve culture,and 19 were positive for valve mNGS.The sensitivity of blood culture,valve culture and valve mNGS in the diagnosis of IE were 40%,15% and 95%,respectively.The detection results of valve mNGS and blood culture or valve culture were consistent at the genus level of bacteria.The relative abundance of genera(P=0.001),number of species sequences(P=0.028),and coverage rate(P=0.003)of valve mNGS were related to the duration of antibiotic use.Valve mNGS could guide the antibiotic therapy in IE patients with negative culture.Conclusion Valve mNGS has high clinical value in the pathogenic diagnosis of IE,which may provide a basis for subsequent antibiotic treatment.