宏基因组二代测序在脓毒症病原学诊断中的应用研究

Application of metagenomic next-generation sequencing in the diagnosis of sepsis pathogens

目的探讨宏基因组二代测序(mNGS)技术在脓毒症病原学诊断中的诊断价值。方法回顾性分析2021年9月至2023年9月内蒙古科技大学包头医学院第二附属医院重症医学科收治的72例脓毒症患者,并根据mNGS检测结果将其分为mNGS阳性组(56例)和mNGS阴性组(16例)。比较2组临床资料,分析血培养及mNGS技术的检出率、检测时间,以及抗生素对病原体检出率的影响等。结果mNGS阳性组、mNGS阴性组临床资料[C-反应蛋白(CRP)水平除外]比较,差异无统计学意义(P>0.05)。mNGS检出率[77.78%(56/72)]高于血培养检出率[38.89%(28/72)],差异有统计学意义(P<0.001)。mNGS检测时间为(2.11±0.46)d,显著短于血培养的(5.39±1.34)d,差异有统计学意义(P<0.05)。血培养及mNGS检测方法一致性中等(Kappa=0.412,P<0.01)。在入科前使用抗生素的54例患者中,mNGS检出率显著高于血培养,差异有统计学意义(P<0.001)。在入科前未使用抗生素的18例患者中,2种检测方法的检出率比较,差异无统计学意义(P=0.687)。CRP水平是mNGS阳性检出率的影响因素(P=0.015,OR=1.024,95%CI:1.005~1.044)。治疗期间换用抗生素患者28 d预后情况与未换用抗生素患者比较,差异无统计学意义(P=0.963)。结论mNGS技术对脓毒症患者病原体的检测能力优于血培养,且耗时短,可检测出罕见病原体,可为早期靶向抗感染治疗提供参考意见,而且,CRP可作为选择mNGS检测的指标之一。

Objective To explore the value of metagenomic next-generation sequencing(mNGS)technology in the diagnosis of sepsis pathogens.Methods The retrospective analysis was conducted on 72 sepsis patients admitted to the Intensive Care Medicine Department of the Second Affiliated Hospital of Baotou Medical College,Inner Mongolia University of Science and Technology from September 2021 to September 2023.According to the results of mNGS test,they were divided into mNGS positive group(56 cases)and mNGS negative group(16 cases).The clinical data of two groups was compared,and the detection rate and detection time of blood culture and mNGS technology,as well as the impact of antibiotics on pathogen detection rate were analyzed.Results There was no statistically significant difference in clinical data[except for C-reactive protein(CRP)levels]between the mNGS positive group and the mNGS negative group(P>0.05).The detection rate of mNGS[77.78%(56/72)]was higher than that of blood culture[38.89%(28/72)],and the difference was statistically significant(P<0.001).The mNGS detection time was(2.11±0.46)days,significantly shorter than(5.39±1.34)days of blood culture,and the difference was statistically significant(P<0.05).The consistency between blood culture and mNGS detection methods was moderate(Kappa=0.412,P<0.01).Among the 54 patients who used antibiotics before admission,the detection rate of mNGS was significantly higher than that of blood culture,and the difference was statistically significant(P<0.001).Among the 18 patients who did not use antibiotics before admission,there was no statistically significant difference in the detection rate between the two testing methods(P=0.687).The level of CRP was a factor affecting the positive detection rate of mNGS(P=0.015,OR=1.024,95%CI:1.005-1.044).There was no statistically significant difference in the 28 day prognosis between patients who switched to antibiotics during treatment and those who did not(P=0.963).Conclusion The detection ability of mNGS technology for pathogens in sepsis patients is superior to blood culture,and it takes less time to detect rare pathogens.It can provide reference for early targeted anti infection,and CRP can be used as one of the indicators for selecting mNGS detection.