mNGS检测关节假体周围感染病原菌的分析

Analysis of pathogenic bacteria in the detection of periprosthetic joint infection by mNGS

目的探析宏基因组二代测序技术(mNGS)在假体周围感染(PJI)病原菌检测中的作用。方法选取2020年1月—2021年12月天津金匙医学检验实验室收治的行关节翻修手术患者200例,其中包括膝关节126例,髋关节74例,对患者关节液或滑膜组织标本中的病原菌行常规细菌培养和mNGS检测,比较两种检测方式诊断阳性率,诊断效能(敏感度、特异度、阳性预测值、阴性预测值、诊断符合率)和检测时间差异性。结果mNGS检测阳性率高于常规细菌培养检测,差异有统计学意义(P<0.05)。mNGS诊断敏感度、阴性预测值、诊断符合率高于常规细菌培养,但特异度、阳性预测值比常规细菌培养检测低,差异均有统计学意义(P<0.05)。mNGS检测检出时间为(1.87±0.29)d,短于常规细菌培养检测检出的(5.17±0.59)d,差异有统计学意义(P<0.05)。结论mNGS检测能有效识别PJI患者病原菌,具有较高诊断敏感度和诊断符合率,且在检出时间有明确优势,在PJI中具有较高的诊断效率,能为PJI诊治提供有效的指导建议。

Objective To explore the role of metagenomic next-generation sequencing(mNGS)in the detection of pathogenic bacteria in periprosthetic joint infection(PJI).Methods A total of 200 patients'who underwent joint revision surgery in Tianjin Jinkey Medical Technology Co.,Ltd.Laboratory from January 2020 to December 2021 were selected,with including 126 knee joints and 74 hip joints.Routine bacterial culture and mNGS detection were performed on pathogenic bacteria in joint fluid or synovial tissue samples of patients.The diagnostic positivity rate,diagnostic efficacy(sensitivity,specificity,positive predictive value,negative predictive value,diagnostic consistency),and detection time differences were compared between two detection methods.Results The diagnostic positivity rate in the mNGS detection was higher than that in the conventional bacterial culture detection,and the difference was statistically significant(P<0.05).The diagnostic sensitivity,negative predictive value and diagnostic accuracy of the mNGS detection were higher than those of the conventional bacterial culture detection,but the specificity and positive predictive value were lower than those of the conventional bacterial culture detection,and the differences were statistically significant(P<0.05).The detection time of mNGS detection was(1.87±0.29)d,which was shorter than that of conventional bacterial culture detection with(5.17±0.59)d,and the difference was statistically significant(P<0.05).Conclusion mNGS detection could effectively identify pathogenic bacteria in PJI patients,had high diagnostic sensitivity and diagmostic accuracy,and had a clear advantage in detection time.It had a high diagnostic efficiency in the PJI and could provide effective guidance and suggestions for the diagnosis and treatment of PJI.