摘要
目的 探讨宏基因组二代测序(mNGS)、传统检测方法对重症感染病原体的诊断性能。方法 选取2022年3月至2023年4月收治的100例重症感染患者,均收集肺泡灌洗液与血液样本,均行传统微生物培养、mNGS检测,统计mNGS与传统检测结果,以临床最终诊断为金标准,比较mNGS与传统检测对病原体感染的诊断性能及两种检测方法诊断不同样本病原体类型的符合率,并分析mNGS与传统检测对炎症指标[白细胞计数(WBC)、降钙素原(PCT)、C反应蛋白(CRP)]的影响。结果 临床诊断肺部感染100例,脓毒症68例。其中70例进行肺泡灌洗液采样检测,mNGS检测检出病原体61例,传统检测检出病原体43例;71例进行血液样本采样检测,mNGS检测检出病原体33例,传统检测检出病原体8例。肺泡灌洗液样本、血液样本mNGS检测对重症感染病原体诊断的准确度、敏感度均高于传统检测(P<0.01);肺泡灌洗液样本采用mNGS检测诊断病原体类型的符合率最高,高于肺泡灌洗液样本传统检测及血液样本mNGS检测、传统检测(P<0.01);肺泡灌洗液样本、血液样本mNGS检测符合率均高于传统检测(P<0.01)。100例患者中共有54例患者在治疗过程中调整用药方案,mNGS组36例、传统组18例,mNGS组调整用药后5 d PCT、CRP下降幅度大于传统组(P<0.05)。结论 相较于传统检测,mNGS检测有利于提高对重症感染病原体诊断性能,依据mNGS检测结果调整用药方案,可减轻患者炎症状态。
Objective To explore the diagnostic performance of metagenomics next-generation sequencing(mNGS)and traditional detection methods in the diagnosis of pathogens in severe infections.Methods A total of 100 patients with severe infections admitted from March 2022 to April 2023 were selected.Samples of bronchoalveolar lavage fluid(BALF)and blood were collected for traditional microbial culture and mNGS detection,and the results of mNGS technology and traditional detection were statistically analyzed.The final clinical diagnosis was used as the gold standard,the diagnostic performance of mNGS technology and traditional detection were compared for pathogen infection,as well as the concordance rate of the two detection methods for diagnosing pathogen types in different sample sources.The impact of mNGS technology and traditional detection on inflammatory indicators[white blood cell count(WBC),procalcitonin(PCT),C-reactive protein(CRP)]was analyzed.Results Based on clinical diagnosis,there were 100 patients with lung infection and 68 with sepsis.Among them,70 patients underwent BALF sampling and testing,with 61 pathogens detected by mNGS and 43 pathogens detected by traditional detection methods.In addition,71 patients underwent blood sample sampling and testing,with 33 pathogens detected by mNGS and 8 pathogens detected by traditional detection methods.The accuracy and sensitivity of mNGS technology in diagnosing pathogens in severe infections from BALF and blood samples were higher than those of traditional detection methods(P<0.01);the consistency rate of pathogen type diagnosis using mNGS based on BALF samples was the highest,which was higher than that of traditional detection based on BALF samples,mNGS based on blood samples,and traditional detection(P<0.01);the consistency rate of mNGS detection based on BALF and blood samples was higher than that of traditional detection(P<0.05).Among the 100 patients,54 patients had their medication regimen adjusted during treatment,including 36 patients in mNGS group and 18 in the traditional group,respectively.The decrease in PCT and CRP levels in the mNGS group was greater than that in the traditional group within 5 d after medication adjustment(P<0.05).Conclusion Compared with traditional detection,mNGS technology is beneficial to improving the diagnostic performance of pathogens in severe infections,and adjusting the medication regimen based on the mNGS detection results can improve the inflammatory state of patients.
作者
张松盛
徐舟
谢洁瑶
潘挺军
罗伟文
张敏
钟映玉
邹新辉
ZHANG Songsheng;XU Zhou;XIE Jieyao;PAN Tingjun;LUO Weiwen;ZHANG Min;ZHONG Yingyu;ZOU Xinhui(Department of Critical Care Medicine,Meizhou People's Hospital,Meizhou,Guangdong 514000,China;Department of Emergency Medicine,Meizhou People's Hospital,Meizhou,Guangdong 514000,China)
出处
《临床误诊误治》
2025年第15期67-71,共5页
Clinical Misdiagnosis & Mistherapy
基金
广东省医学科学技术研究基金项目(B2023335)
梅州市科技计划项目(221208112056567)。
关键词
重症感染
病原体
宏基因组二代测序
传统微生物培养
肺泡灌洗液
诊断
severe infection
pathogen
metagenomics next-generation sequencing
traditional microbial culture
bronchoalveolar lavage fluid
diagnosis
作者简介
张松盛,本科,主治医师。主要从事重症医学方向研究。
