mNGS在疑似中枢神经系统感染诊断中的应用价值

The application value of mNGS in the diagnosis of suspected central nervous system infection

目的探讨基于宏基因组第二代测序技术(mNGS)在综合重症病房(ICU)疑似中枢神经系统(CNS)感染患者中的应用价值,为综合ICU患者CNS感染的快速精准诊断提供参考。方法收集行脑脊液mNGS检测的患者资料82例,根据纳入标准,取52例疑似CNS感染、同时有送检脑脊液常规、生化、培养和mNGS检测结果的患者进行最终数据分析,以临床诊断CNS感染为“金标准”,比较传统检测和mNGS检测两种方法检出率差异及相对于“金标准”的应用价值。结果52例患者中,最终CNS感染患者32例,其中24例脑脊液mNGS阳性,5例脑脊液培养阳性,两种方法的灵敏度、特异度分别为75.00%vs 15.63%、55.00%vs 95.00%,阳性、阴性预测值分别为72.73%vs 83.33%、57.89%vs 41.00%;两种方法检出率差异无统计学意义(P>0.05)。32例CNS感染中,细菌性感染14例,病毒性感染9例,真菌性感染2例以及其他感染7例,其中mNGS检测病毒感染病原体灵敏度66.70%,特异度95.30%,阳性预测值为75.00%,阴性预测值为93.20%,与临床最终诊断金标准间具有高度一致(Kappa值=0.649,P<0.01)。结论脑脊液mNGS对于中枢病毒感染相较于细菌感染具有更高的诊断准确率,建议采用mNGS检测对疑似中枢病毒感染的患者进行快速筛查。

Objective To explore the application value of metagenomic second-generation sequencing(mNGS)in patients with suspected central nervous system(CNS)infection in the general intensive care unit(ICU),and to provide reference for rapid and accurate diagnosis of central nervous system infection patients in the general ICU.Methods The data of 82 patients who underwent cerebrospinal fluid mNGS examination in the general ICU of our hospital from 2018 to 2021 were collected.According to the inclusion criteria,52 patients with suspected CNS infection,who had undergone routine biochemical and culture testing as well as mNGS on cerebrospinal fluid samples,were included in the final data analysis.The clinical diagnosis of CNS infection was taken as the"gold standard",and the application value of the two methods,traditional culture and mNGS,for clinical diagnosis were compared.Results Among the 52 patients,32 were finally diagnosed with CNS infection,24 of them were positive for mNGS in cerebrospinal fluid,and 5 were positive in culture of cerebrospinal fluid.The sensitivity and specificity of the two methods were 75.00%vs 15.63%and 55.00%vs 95.00%,The negative predictive values were 72.73%vs 83.33%,and 57.89%vs 41.00%,respectively;there was no significant difference in the detection rates between the two methods(P>0.05).Of the 32 patients with CNS infection,14 had bacterial infection,9 had viral infection,2 had fungal infection and 7 had other pathogenic bacteria infection.The sensitivity of mNGS to detect pathogens of viral infection was 66.70%,the specificity was 95.30%,and the positive predictive value was 75.00%,and the negative predictive value was 93.20%,which was highly consistent with the gold standard of clinical final diagnosis(Kappa value=0.649,P<0.01).Conclusion Cerebrospinal fluid mNGS has a higher diagnostic accuracy for central viral infection compared to bacterial infection,and it is recommended to use mNGS for rapid screening of patients with suspected central virus infection.