| 查渝,曹晓光,戴媛媛,等.二代测序技术在脓毒症病原学诊断中的应用价值[J].中国临床保健杂志,2022,25(3):340-344. |
| 二代测序技术在脓毒症病原学诊断中的应用价值 |
| The etiologic diagnosis value of Next-Generation Sequencing(NGS) technology for sepsis pathogens detection |
| 投稿时间：2022-03-01 |
| DOI：10.3969/J.issn.1672-6790.2022.03.011 |
| 中文关键词: 脓毒症 血培养 聚合酶链反应 序列分析 |
| 英文关键词: Sepsis Blood culture Polymerase chain reaction Sequence analysis 〖FL |
| 基金项目:安徽省自然科学基金项目(1908085MH264) |
| 作者 | 单位 | E-mail | | 查渝 | 中国科学技术大学附属第一医院安徽省立医院,急救中心ICU,合肥 230001 | zhouss108@163.com | | 曹晓光 | 中国科学技术大学附属第一医院安徽省立医院,急救中心ICU,合肥 230001 | zhouss108@163.com | | 戴媛媛 | 中国科学技术大学附属第一医院安徽省立医院,细菌室,合肥 230001 | zhouss108@163.com | | 黄羽 | 中国科学技术大学附属第一医院安徽省立医院,急救中心ICU,合肥 230001 | zhouss108@163.com | | 王春艳 | 中国科学技术大学附属第一医院安徽省立医院,急救中心ICU,合肥 230001 | zhouss108@163.com | | 周树生 | 中国科学技术大学附属第一医院安徽省立医院,急救中心ICU,合肥 230001 | zhouss108@163.com |
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| 中文摘要: |
| 目的 探讨二代测序技术(NGS)在脓毒症病原体检测中的运用价值。方法 采用回顾性分析研究,收集2018年1月至2022年1月某三级甲等教学医院收治的82例疑似脓毒症患者的临床资料,采集血标本进行血培养、NGS和聚合酶链反应(PCR)检测,比较3种方法的临床应用价值。结果 血培养、NGS和PCR所需检测时间分别为(5.61±1.22)、(1.32±0.26)和(1.52±0.31)d。82例患者中,诊断为脓毒症62例,非脓毒症患者20例；脓毒症组中有35例未治愈,明显高于非脓毒症组4例(P＜0.05)。61例NGS阳性标本中,检测出病原体主要包括鲍曼不动杆菌10例、肺炎克雷伯杆菌14例、金黄色葡萄球菌4例、巨细胞病毒(CMV)22例、人类疱疹病毒(EBV)13例、单纯疱疹病毒1型(HSV-1)13例、耶氏肺孢子菌8例和烟曲霉5例。12例患者血培养阳性,共计检出13种病原体,包括肺炎克雷伯杆菌3例、铜绿假单胞菌杆菌2例,大肠杆菌2例、鲍曼不动杆菌、伯克霍尔德菌、金黄色葡萄球菌、屎肠球菌、溶血葡萄球菌和白色念珠菌各1例。NGS检测阳性率为74.39%,明显高于血培养的14.63%,差异有统计学意义(P＜0.05)。NGS和血培养ROC曲线下面积、敏感性和特异性分别为0.628、80.6%、45.0%和0.597、19.4%、100%。32例患者行PCR检测,9例阳性患者中发现2种病毒感染(CMV 4例,EBV 5例),检测阳性率为28.13%。结论 NGS检测方法优于传统检测方法,可检测出未知病原体且检测周期较短。 |
| 英文摘要: |
| Objective To evaluate the clinical value of Next-Generation Sequencing (NGS) in the diagnosis of Sepsis pathogens detection.Methods Based on the retrospective reviewing and analyzing of 82 clinical cases of suspected sepsis patients admitted to the department of ICU between January 2018 and January 2022 in a top teaching hospital,this study conducts a comparative and statistical analysis of the clinical value of blood collecting and blood culture method,NGS method and PCR method in the etiologic diagnosis of Sepsis pathogens detection.Results The average detection time required for the three methods was respectively(5.61±1.22) d for blood culture,(1.32±0.26) d for NGS and(1.52±0.31) d for PCR.According to the clinical diagnostic criteria,82 patients with suspected sepsis were divided into sepsis group(62 cases) and non-sepsis group(20 cases).The uncured patients were 35cases in sepsis group while 4 cases in non-sepsis group,which proved that the deteriorating rate of sepsis group is apparently higher than the non-sepsis (P＜0.05).In 61 positive samples of NGS,the pathogens detected mainly included Acinetobacter baumannii (10 cases),Klebsiella pneumoniae (14 cases),Staphylococcus aureus (4 cases),CMV (22 cases),EBV (13 cases),HSV-1 (13 cases),Pneumocystis yersinii (8 cases) and Aspergillus fumigatus (5 cases).Among the 12 positive samples of blood culture,13 pathogens were detected,including Klebsiella pneumoniae (3 cases),Pseudomonas aeruginosa (2 cases),Escherichia coli(2 case),Acinetobacter baumannii(1 case),Burkholderia(1 case),Staphylococcus aureus(1 case),Enterococcus faecium(1 case),Staphylococcus haemolyticus(1 case) and Candida albicans(1 case).The sensitivity of NGS in positive case detection was 74.39%,which was significantly higher than that of blood culture(14.63%),P<0.05.The differences were statistically significant,which could be clearly reflected in the receiver operating characteristic (ROC) curve:The sharp data contrast of sensitivity and specificity between NGS and blood culture was respectively 0.628 vs.0.597,80.6% vs.19.4%,45.0% vs.100%.By PCR,the pathogens were detected in 32 patients,with 2 kinds virus detected in 9 patients(4 cases CMV,5 cases EBV).Conclusions The method of sepsis pathogens detection based on NGS is highly sensitive in detecting unknown pathogens,which is superior to those used traditional methods.Simultaneously,the NGS is shorter than traditional methods. |
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