宏基因组二代测序技术在腹膜透析相关腹膜炎早期诊断中的价值研究

Value of metagenomics next-generation sequencing technology in the early diagnosis of peritoneal dialysisassociated peritonitis

目的比较宏基因组二代测序(m NGS)与传统细菌培养对腹膜透析相关腹膜炎(PDAP)诊断价值的差异。方法回顾性分析2020年3月1日至2022年1月1日中国医科大学附属第一医院腹膜透析中心收治的35例可疑PDAP患者的临床资料,按照诊断方法分组,将mNGS联合细菌培养法定为mNGS组(14例),细菌培养法定为培养组(21例),记录检出结果、报告时间及抗生素相关不良反应等情况。结果mNGS组与培养组诊断准确率分别为100%与66.7%,差异有统计学意义(P<0.05)。在14例1周内存在抗生素暴露的PDAP患者中,mNGS组与培养组诊断准确率分别为100%与25%,mNGS组诊断准确率更高,差异有统计学意义(P<0.05)。mNGS组与培养组结果报告时间为(21.90±1.44)h与(94.24±32.00)h,调整治疗方案时间为(2.14±0.35)d与(4.52±2.01)d,mNGS组报告结果时间及调整治疗方案时间均短于培养组,差异有统计学意义(P<0.05);两组患者治疗期间不良反应发生率为14.3%与33.3%,差异无统计学意义(P>0.05)。结论在PDAP患者中,mNGS技术具有诊断准确率高、耗时短等优点,具有重要的临床应用价值。

Objective To compare the diagnostic value of metagenomic next-generation sequencing(mNGS)with that of traditional bacterial culture in peritoneal dialysis-associated peritonitis(PDAP).Methods The clinical data of 35 patients with suspected PDAP admitted to the Peritoneal Dialysis Center of the First Hospital of China Medical University from March1,2020 to January 1,2022 were retrospectively analyzed.The m NGS combined with bacterial culture was classified as the mNGS group(14 cases)and bacterial culture was classified as the culture group(21 cases)according to the diagnostic method,and the detection results,reporting time and antibiotic-related adverse reactions were recorded.Results The diagnostic accuracy of m NGS and culture groups were 100%and 66.7%,respectively,with statistically significant differences(P<0.05).Among 14 PDAP patients with antibiotic exposure within one week,the diagnostic accuracy was100%in the mNGS group and 25%in the culture group,and the diagnostic accuracy was higher in the mNGS group,with statistically significant differences(P<0.05).The time to report results in the mNGS group and the culture group was(21.90±1.44)h and(94.24±32.00)h,and the time to adjust the treatment regimen was(2.14±0.35)d and(4.52±2.01)d;the mNGS group took less time to report results and adjust treatment regimens than the culture group,and the difference was statistically significant(P<0.05);the incidence of adverse reactions during treatment was 14.3%and 33.3%in the two groups,with no statistically significant difference(P>0.05).Conclusion For patients with peritoneal dialysis-related peritonitis,mNGS technology has important clinical application value,with the advantages of high diagnostic accuracy and short time consumption.