下一代测序技术在脓毒症患者病原学诊断中的Meta分析

Meta-analysis of Next-generation Sequencing in the Etiological Diagnosis of Sepsis Patients

目的系统评价下一代测序技术在脓毒症患者病原学诊断中的应用价值。方法检索PubMed、Embase、Web of Science、The Cochrane Library、维普网、中国知网、万方数据知识服务平台和SinoMed等数据库,检索年限为2018年1月~2022年9月。比较下一代测序技术和传统病原学检测方法对脓毒症检测的阳性率、病原体检出时间、病毒检出率、28天病死率和重症医学科(intensive care unit,ICU)住院时长。使用Review Manager 5.4.1软件进行Meta分析,绘制漏斗图对纳入文献进行发表偏倚分析。结果共纳入18篇文献。Meta分析结果显示,下一代测序组阳性率为72.3%(1403/1941),显著高于传统病原学检测组[28.4%(556/1958),OR=7.03,95%CI:4.52~10.95,P<0.01];病原体检出时间显著低于传统病原学检测组(OR=-34.22,95%CI:-41.95~-26.48,P<0.01);病毒检出率显著高于传统病原学检测组(OR=57.82,95%CI:19.27~173.46,P<0.01);ICU住院时长显著低于传统病原学检测组(WMD=-9.37,95%CI:-16.28~-2.46,P<0.01);两组28天病死率比较差异无统计学意义(OR=0.43,95%CI:0.02~8.47,P=0.58)。结论与传统病原学检测方法比较,下一代测序技术能够提高脓毒症患者病原检测的阳性率和病毒检出率,缩短病原体检出时间和ICU住院时长,对脓毒症的诊断和治疗具有更高的应用价值。

Objective To systematically evaluate the application value of next-generation sequencing technology in the etiological diagnosis of patients with sepsis.Methods Databases such as PubMed,Embase,Web of Science,The Cochrane Library,VIP,CNKI,WanFang Data Knowledge Service platform and SinoMed were searched from January 2018 to September 2022.The positive rate of sepsis detection,pathogen detection time,virus detection rate,28 days mortality rate and length of stay in intensive care unit(ICU)were compared between next-generation sequencing technology and traditional etiological detection method.Meta-analysis was performed using Review Manager 5.4.1software,and funnel plot was pictured to analyze the publication bias of the included literatures.Results A total of 18 literatures were included.The results of Meta-analysis showed that the positive rate of next-generation sequencing group was 72.3%(1403/1941),which was significantly higher than that of the traditional etiological detection group[28.4%(556/1958),OR=7.03,95%CI:4.52-10.95,P<0.01];the time of pathogen detection was significantly lower than that of traditional etiological detection group(OR=-34.22,95%CI:-41.95--26.48,P<0.01);the virus detection rate was significantly higher than that of traditional etiological detection group(OR=57.82,95%CI:19.27-173.46,P<0.01);the length of stay in ICU was significantly lower than that of traditional etiological detection group(WMD=-9.37,95%CI:-16.28--2.46,P<0.01);there was no significant difference in 28 days mortality between the two groups(OR=0.43,95%CI:0.02-8.47,P=0.58).Conclusion Compared with traditional etiological detection methods,next-generation sequencing technology can improve the positive rate of pathogen detection and virus detection in sepsis patients,shorten the time of pathogen physical examination and the length of stay in ICU,and has higher application value for the diagnosis and treatment of sepsis.