2024 年第 11 期 第 19 卷

宏基因组二代测序在儿童重症监护病房重症感染性疾病病原体诊断中的应用价值

The application value of metagenomic next-generation sequencing in the pathogen diagnosis of severe infectious diseases in pediatric intensive care unit

作者：莫连芹黄栋潘飞飞娄磊成小蓉

英文作者：Mo Lianqin Huang Dong Pan Feifei Lou Lei Cheng Xiaorong

单位：上海交通大学医学院附属上海儿童医学中心贵州医院贵州省人民医院儿童重症医学科，贵阳550000

英文单位：Department of Children′s Critical Care Medicine Guizhou Branch of Shanghai Children′s Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine Guizhou Provincial People′s Hospital Guiyang 550000 China

关键词：儿童重症监护病房；宏基因组二代测序；重症感染性疾病；病原学；儿童

英文关键词：Pediatricintensivecareunit;Metagenomicnext-generationsequencing;Severeinfectiousdiseases;Etiology;Children

• 摘要：

• 目的 探讨宏基因组二代测序（mNGS）在儿童重症监护病房（PICU）重症感染性疾病病原体诊断中的应用价值。方法 选取2021年10月至2023年7月贵州省人民医院PICU收治的考虑重症感染送检微生物培养及mNGS检查的86例患儿为研究对象进行回顾性分析，共送检113份标本。比较mNGS与微生物培养法病原体检出率的差异及病原学特征。结果 86例患儿共采集113份标本送检，mNGS的病原体总检出率高于微生物培养法［68.1%（77/113）比23.9%（27/113）］，差异有统计学意义（P＜0.05）。在外周血、痰液、脑脊液标本方面，mNGS的病原体检出率均高于微生物培养法［65.0%(26/40)比25.0%(10/40)、97.1%(34/35)比28.6%(10/35)、37.5%(9/24)比12.5%(3/24)］（均P＜0.05）。mNGS最常见检出的感染类型为混合感染26.5%（30/113），其次是细菌感染20.4%（23/113）和病毒感染17.7%（20/113）。微生物培养法最常见检出的感染类型为细菌感染17.7%（20/113），其次为真菌感染4.4%（5/113）。mNGS混合感染和病毒感染检出率均高于微生物培养法，差异均有统计学意义（均P＜0.05）。mNGS对1种病原体、2种病原体、3种及以上病原体、1类（类数指细菌、真菌、病毒、其他4种分类）病原体、2类病原体检出率均高于微生物培养法，差异均有统计学意义（均P＜0.05）。31.4%（27/86）的患儿根据mNGS结果调整治疗并获益。结论 mNGS在PICU重症感染性疾病病原体诊断中比微生物培养法有更高的检出率，且对混合感染、病毒感染有明显优势，可作为微生物培养法的补充，指导临床治疗。

• Objective To explore the application value of metagenomic next-generation sequencing (mNGS) in the pathogen diagnosis of severe infectious diseases in pediatric intensive care unit (PICU). Methods A retrospective analysis was conducted on 86 pediatric patients admitted to the PICU of Guizhou Provincial People′s Hospital from October 2021 to July 2023, all of whom underwent microbial culture and mNGS for severe infections. In total, 113 specimens were submitted for examination.The differences in pathogen detection rate and pathogenic characteristics between mNGS and microbial culture were compared. Results A total of 113 samples were collected from 86 children. The total pathogen detection rate of mNGS was higher than that of microbial culture method［68.1%（77/113） vs 23.9%（27/113）］（P＜0.05）. In peripheral blood, sputum and cerebrospinal fluid samples, the pathogen detection rates of mNGS were higher than those of microbial culture method ［65.0%(26/40) vs 25.0%(10/40), 97.1%(34/35) vs 28.6%(10/35), 37.5%(9/24) vs 12.5%(3/24)］（all P＜0.05）. The most common infection type detected by mNGS was mixed infection (26.5%, 30/113), followed by bacterial infection (20.4%, 23/113) and viral infection (17.7%, 20/113). The most common infection type detected by microbial culture method was bacterial infection (17.7%, 20/113), followed by fungal infection (4.4%, 5/113). The detection rates of mixed infection and virus infection by mNGS method were higher than those by microbial culture method (both P＜0.05). The detection rates of mNGS for 1 pathogen, 2 pathogens, 3 or more pathogens, 1 type of pathogen (the number of categories refers to bacteria, fungi, viruses, and other 4 categories), and 2 types of pathogens are all higher than those of microbial culture methods (all P＜0.05). 31.4% (27/86) of the children had their treatment adjusted based on the results of mNGS and benefited from it. Conclusion mNGS has a higher detection rate than microbial culture in the diagnosis of infectious diseases in PICU, and it has obvious advantages in mixed infections and viral infections, which can be used as a supplement to microbial culture and guide clinical treatment.