外周血mNGS 检测在血液病伴发热患者中的临床分析

Clinical analysis of metagenomic next-generation sequencing assay in the peripheral blood in patients with hematological condition and fever

目的:探讨外周血宏基因组二代测序技术(mNGS)在血液病伴发热患者中的临床应用价值。方法:回顾性分析2022年1月~2023年3月在皖南医学院第二附属医院血液科住院治疗的血液病合并发热并进行外周血mNGS检测的48例患者,总结其临床及实验室资料,对影响mNGS病原学结果的因素进行分析。结果:48例患者发热前住院时间7.50(2.00,25.25)d。常见的感染部位依次为肺部39例(81.25%),多重感染6例(12.50%)和上呼吸道感染4例(8.33%);mNGS检测中位检出时间2.00(2.00,3.00)d,检出细菌7例(14.58%),真菌10例(20.83%),病毒21例(43.75%),少见病原体1例(2.08%)。其中2种以上混合感染11例(22.92%)。外周血mNGS常见病原体检出率高于血培养(P<0.001),mNGS中位检出时间较血培养和分泌物培养检出时间均缩短(P<0.05);mNGS阳性的CRP表达水平高于mNGS阴性(P<0.05)。结论:血液病合并发热患者外周血mNGS病毒及真菌检出率高、混合感染比例高,mNGS和传统培养方式相比更高效和灵敏,且对于临床治疗具有一定的指导价值,因此推荐应用于血液病伴发热患者的临床。

Objective:To investigate the clinical application value of metagenomic next-generation sequencing(mNGS)test in patients of hematological diseases concomitant with fever.Methods:The clinical and laboratory data were reviewed in 48 hospitalized patients of hematological condition complicated with fever treated in the Hematology Department of our hospital between January 2022 and March 2023,and the factors affecting mNGS findings were analyzed.Results:The days of hospital stay were 7.50(2.00-25.25)before development of fever symptom in the 48 patients.The common sites of infection were lungs in 39 cases(81.25%).Multiple infections were seen in 6 cases(12.5%)and another 4 cases were involved in upper respiratory tract infection(8.3%).The median detection time by mNGS test was 2.00(2.00-3.00)days.Bacteria,fungi,viruses and rare pathogens were detected in 7(14.58%),10(20.83%),21(43.75%)and 1 case(2.08%),respectively.Eleven cases(22.92%)were mixed infections with 2 or more species of pathogens.The detection rate of common pathogens in the peripheral blood in mNGS test group was significantly higher than that in the blood culture group(P<0.001),and the median detection time by mNGS assay was significantly shorter compared to both blood and secretion cultures(P<0.05).CRP expression level was higher in the mNGS-positive group than in the negative group(P<0.05).Conclusion:The detection rate for virus and fungi is high by mNGS test in the peripheral blood of patients with hematological diseases complicated with fever,and the proportion of mixed infections appears higher in this group of patients as well.Compared with conventional culturing methods,mNGS is more efficient and sensitive,suggesting that this assay can be recommended for clinical application in patients of hematological condition concomitant with fever.