摘要
目的 探讨宏基因二代测序技术对疑似中枢神经系统感染性疾病的病原诊断价值。方法 收集2020年7月至2021年12月就诊于天水市第一人民医院神经内一科的疑似中枢神经系统感染患者40例,全部入组患者行血常规、病毒五项、呼吸道病原体联检、脑脊液常规与生化、脑脊液抗酸染色与墨汁染色、脑脊液结核DNA与单纯疱疹病毒DNA检测、脑脊液流行性乙型脑炎抗体测定(高度疑似乙脑患者),头颅MRI检查。同时外送脑脊液行宏基因组二代测序检测。结果 40例疑似中枢神经系统感染患者,脑脊液宏基因二代测序DNA检测40例,阳性36例,包括病毒DNA 17例(42.50%)、化脓性细菌5例(12.50%)、结核分枝杆菌复合群2例(5.00%)、真菌2例(5.00%)、罕见病原体10例(25.00%);RNA检测14例,均为阴性。最终临床诊断病毒性脑炎23例,化脓性脑膜炎5例,流行性乙型脑炎、李斯特脑炎、结核性脑膜炎各3例,真菌脑炎、布氏杆菌脑炎、伤寒脑炎各1例,宏基因二代测序敏感性85.19%,假阳性13例,假阳性率32.50%,假阴性4例,假阴性率10.00%。DNA病毒诊断符合率39.13%,病原体特异性序列数>10,诊断符合率为100.00%,化脓性细菌诊断符合率100.00%,结核分枝杆菌诊断符合率66.67%,真菌诊断符合率100.00%,罕见病原体诊断符合率100.00%,流行性乙型脑炎病毒诊断符合率0。结论 宏基因二代测序对确定DNA病毒、细菌、结核分枝杆菌、真菌、罕见病原体感染敏感性高,但其对RNA病毒流行性乙型脑炎病毒的诊断敏感性低,临床怀疑流行性乙型脑炎时,需谨慎分析宏基因二代测序的结果,与常规检验方法结合,综合判定,以早期诊断,精准治疗,改善患者预后。
Objective To investigate the value of metagenomic next-generation sequencing technology for diagnosing pathogen of suspected infectious diseases of the central nervous system.Methods A total of 40 patients with suspected infectious diseases of the central nervous system who visited the Department of NeurologyⅠof the First People’s Hospital of Tianshui from July 2020 to December 2021 were selected as study subjects.All subjects underwent blood routine,five-item virus-related tests,respiratory virus co-test,cerebrospinal fluid routine test and biochemistry,antacid staining and ink staining tests for cerebrospinal fluid,tests of tuberculosis DNA and herpes simplex virus DNA in cerebrospinal fluid,test of epidemic B encephalitis antibody in cerebrospinal fluid(for patients with highly suspected B encephalitis),and cranial MRI examination.The cerebrospinal fluid was also sent for metagenomic next-generation sequencing.Results 36 positive patients of all the 40 patients undergoing metagenomic next-generation sequencing for cerebrospinal fluid DNA test including 17 with viral DNA(42.50%),5 with septic bacteria(12.50%),2 with mycobacterium tuberculosis complex(5.00%),2 with fungi(5.00%),and 10 with rare pathogens(25.00%).14 patients were tested negative RNA.The final clinical diagnos is found 23 patients with viral encephalitis,5 patients with septic meningitis,3 patients each with epidemic B encephalitis,Listeria encephalitis and tuberculous meningitis,1 patient each with fungal encephalitis,Brucellosis encephalitis and typhoid encephalitis,with a sensitivity of 85.19%,false-positive cases of 13,false-positive rate of 32.50%,false-negative cases of 4,and false-negative rate of 10.00%for metagenomic next-generation sequencing.The diagnostic compliance rate was 39.13%for DNA virus,100.00%for pathogen-specific sequence number>10,100.00%for septic bacteria,66.67%for Mycobacterium tuberculosis,100.00%for fungi,100.00%for rare pathogens,and 0 for epidemic B encephalitis virus.Conclusion Metagenomic next-generation sequenc
作者
林霞
颉满珍
王根绪
张庆华
赵傲楠
LIN Xia;XIE Manzhen;WANG Genxu;ZHANG Qinghua;ZHAO Aonan(Department of NeurologyⅠ,the First People's Hospital of Tianshui,Gansu,Tianshui 741000,China;Department of Neurology,Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)
出处
《中国医药科学》
2023年第10期15-19,共5页
China Medicine And Pharmacy
基金
甘肃省天水市科技支撑计划项目(2021-SHFZKJK-7976)。
关键词
宏基因二代测序技术
中枢神经系统感染性疾病
血清学化验
脑脊液
头颅MRI
Metagenomic next-generation sequencing technology
Infectious diseases of the central nervous system
Serological assays
Cerebrospinal fluid
Cranial MRI
