mNGS对肝硬化自发性腹膜炎患者的诊断与预后的临床应用价值

Clinical application value of mNGS in the diagnosis and prognosis of patients with spontaneous peritonitis in cirrhosis

目的探究宏基因组二代测序(mNGS)对于自发性细菌性腹膜炎患者的早期诊断与预后的价值。方法纳入2021年3月至2023年3月期间肝硬化腹水患者60例。进行腹水培养和腹水mNGS检测。比较mNGS阳性与阴性组患者一般临床资料、APRI指数、FIB-4指数、MELD评分、MELD-Na评分和Child-Pugh评分。采用腹水多核白细胞计数(PMN)联合腹水mNGS诊断自发性细菌性腹膜炎。结果2组患者的基本资料差异无统计学意义(P>0.05)。PMN联合腹水mNGS检测诊断自发性细菌性腹膜炎的敏感度为86.67%,特异度为78.86%。随访结果显示,mNGS阳性组具有更高的不良事件发生率、病死率和肝硬化相关指标评分。腹水mNGS阳性组和腹水mNGS阴性组的MELD评分分别为18.25和13.11、MELD-Na评分分别为23.82±11.77和14.58+11.27、Child-Pugh评分分别为11.25和9.75。结论PMN联合mNGS检测诊断自发性细菌性腹膜炎优于联合腹水培养,mNGS阳性与肝硬化自发性细菌性腹膜炎患者发生不良预后有较高的相关性。

Objective To investigate the diagnosis and prognosis value of metagenomic Next-Generation Sequencing(mNGS)assay in patients with spontaneous bacterial peritonitis by comparing the results of mNGS and ascites culture from patients with liver cirrhosis.Methods Sixty inpatients diagnosed with cirrhosis and met the inclusion criteria were selected from our hospital between March 2021 and March 2023.Ascites specimens were collected using standardized operation,and both ascites culture and ascites mNGS assay were performed.The patients'general clinical data,etiology of cirrhosis,personal medical history,and antibiotic use were recorded.The scoring indexes used included APRI index,FIB-4 index,MELD score,MELD-Na score and Child-Pugh score.Results There was no significant difference in the patients'basic information and etiological composition of cirrhosis(P>0.05).The positive detection rate of ascitic fluid polymorphonuclear leukocyte counting method combined with ascitic fluid mNGS for SBP in cirrhosis was significantly higher than the detection method combined with ascitic fluid culture.The combined counting method and mNGS assay demonstrated a sensitivity of 86.67%and a specificity of 78.86%.Statistical results during the follow-up period revealed that the mNGS positive group had a higher incidence of adverse events,mortality rate,and liver cirrhosis related index scores.The mean MELD scores of the ascites mNGS positive group and the ascites mNGS negative group were 18.25 and 13.11,respectively.As for the mean MELD Na scores,the ascites mNGS positive group reported 23.82±11.77,while the ascites mNGS negative group reported 14.58±11.27.The MELD score and MELD-Na score for patients with mNGS positive ascites were significantly higher than those for patients with mNGS negative ascites.Moreover,the average Child Pugh scores for the two groups of patients were 11.25 and 9.75,respectively.The Child Pugh scores of patients with mNGS positive ascites were significantly higher than those of patients with mNGS negative ascites.Conclusion The combination of PMN count and mNGS was found to be more effective than ascites culture in guiding early treatment.Furthermore,a positive mNGS test was strongly associated with a poor prognosis in patients with cirrhotic SBP.These findings suggest that mNGS test can serve as improtant observational and predictive indicators of patient prognosis,making it a valuable tool for predicting adverse events during follow-up.