宏基因组二代测序在儿童重症感染中的应用价值

Value of metagenomic next-generation sequencing in children with severe infectious diseases

摘要:

目的 分析宏基因组二代测序（metagenomic next-generation sequencing，mNGS）在儿童重症感染性疾病中的应用价值。 方法 对2018年6月至2020年12月温州医科大学附属第二医院收治的29例重症感染患儿的临床资料及实验室检查结果进行分析。29例患儿的29份标本（外周血标本27份，胸水标本2份）进行传统病原体培养，同时送29份同类型标本进行mNGS病原体检测。 结果 29例患儿传统病原体培养阳性2例，检出病原体2株，检出率为7%（2/29）；而mNGS阳性20例，检出病原体38株，检出率为69%（20/29）。mNGS病原体检出率高于传统病原体培养（Ｐ<0.05），并且能检出传统培养法难以检出的病毒、真菌及其他特殊病原体，如羌虫病东方体。单因素分析显示，性别、血常规、C-反应蛋白、降钙素原、D-二聚体、影像学检查结果，以及入院前是否使用抗生素不会影响mNGS的检测结果（Ｐ>0.05）。 结论 mNGS比传统病原体培养更灵敏且干扰因素少，能够有效检出传统病原体培养阴性病例的病原体，可为儿童重症感染性疾病的病原学诊断提供有力帮助。

Abstract:

Objective To study the application value of metagenomic next-generation sequencing (mNGS) in children with severe infectious diseases. Methods An analysis was performed on the clinical data and laboratory test results of 29 children with severe infection who were admitted to the Second Affiliated Hospital of Wenzhou Medical University from June 2018 to December 2020. Conventional pathogen culture was performed for the 29 specimens (27 peripheral blood specimens and 2 pleural effusion specimens) from the 29 children, and mNGS pathogen detection was performed at the same time. Results Among the 29 children, 2 tested positive by conventional pathogen culture with 2 strains of pathogen, and the detection rate was 7% (2/29); however, 20 children tested positive by mNGS with 38 strains of pathogen, and the detection rate was 69% (20/29). The pathogen detection rate of mNGS was significantly higher than that of conventional pathogen culture (P<0.05), and mNGS could detect the viruses, fungi, and other special pathogens that conventional pathogen culture failed to detect, such as Orientia tsutsugamushi. The univariate analysis showed that gender, routine blood test results, C-reactive protein, procalcitonin, D-dimer, radiological findings, and whether antibiotics were used before admission did not affect the results of mNGS (P>0.05). Conclusions Compared with conventional pathogen culture, mNGS is more sensitive for pathogen detection, with fewer interference factors. Therefore, it is a better pathogenic diagnosis method for severe infectious diseases in children.