宏基因捕获法二代测序技术在感染性胰腺坏死病原学诊断中的价值

The clinical application value of next-generation sequencing technology based on metagenomics capture for identifying pathogens in infected pancreatic necrosis

摘要:

背景与目的 早期病原学精准诊断是改善感染性胰腺坏死（IPN）患者预后的突破口之一，但目前临床上缺乏早期精准识别IPN的高效方法。本研究探讨基于宏基因捕获法（MetaCAP）的二代测序技术在IPN病原学诊断中的应用价值。方法 采用前瞻性研究方法，选取2024年1月—7月中南大学湘雅医院29例疑似急性坏死性胰腺炎患者进行血MetaCAP检测和常规病原学培养。将胰周积液病原学培养结果作为金标准，比较两种检测方法的诊断效能。结果 由于3例未获胰周积液培养结果，纳入最终分析的病例总数为26例。全组病死率为23.1%（6/26）。住院期间，确诊IPN的病例为9例（34.6%）。MetaCAP诊断IPN的敏感度和阴性预测值均明显高于常规病原学培养（77.8% vs. 11.1%，P=0.031；86.7% vs. 65.2%，P=0.032），而两种方法的特异度（76.5% vs. 88.2%，P=0.689）和阳性预测值（63.6% vs. 33.3%，P=0.347）差异无统计学意义。MetaCAP的平均检测耗时33（20~49）h，微生物培养耗时125（45~142）h，差异有统计学意义（P<0.001）。血MetaCAP检测的平均费用为2 500元/例，但MetaCAP检测仅占平均住院费用的1.19%。结论 MetaCAP在IPN的早期病原学诊断中具有重要价值，且耗时较短，有较好的检验效能和卫生经济学价值，具有良好的临床应用前景。

Abstract:

Background and Aims Accurate early pathogen diagnosis is a breakthrough for improving the prognosis of infectious pancreatic necrosis (IPN) patients. However, there is currently a lack of efficient methods for early identification of IPN in clinical settings. This study was performed to assess the application value of next-generation sequencing technology based on metagenomic capture (MetaCAP) in the pathogen diagnosis of IPN.Methods A prospective study was conducted on 29 patients suspected of having acute necrotizing pancreatitis at Xiangya Hospital of Central South University between January and July 2024. Blood samples were tested using MetaCAP and conventional pathogen culture. The results of peritoneal fluid pathogen culture were used as the gold standard to compare the diagnostic efficacy of the two methods.Results Due to three cases lacking peritoneal fluid culture results, a total of 26 cases were included in the final analysis. The overall mortality rate was 23.1% (6/26). During hospitalization, 9 cases (34.6%) were diagnosed with IPN. The sensitivity and negative predictive value of MetaCAP for diagnosing IPN were significantly higher than those of conventional pathogen culture (77.8% vs. 11.1%, P=0.031; 86.7% vs. 65.2%, P=0.032), while the differences in specificity (76.5% vs. 88.2%, P=0.689) and positive predictive value (63.6% vs. 33.3%, P=0.347) between the two methods were not statistically significant. The average detection time for MetaCAP was 33 (20-49) h, while microbial culture took 125 (45-142) h, with a significant difference (P<0.001). The average cost for blood MetaCAP testing was 2 500 yuan per case, but it accounted for only 1.19% of the average hospitalization cost.Conclusion MetaCAP has significant value in the early pathogen diagnosis of IPN, with a shorter detection time, good testing efficacy, and health-economic value, demonstrating a promising clinical application prospect.