高通量测序技术在儿童脓毒症病原学诊断中的效能评价-现代医学

高通量测序技术在儿童脓毒症病原学诊断中的效能评价

单位：江门市妇幼保健院PICU, 广东江门 529000

分类号：R725.1

出版年·卷·期（页码）：2022·50·第八期（1022-1027）

摘要：

目的：探讨高通量测序技术(mNGS)在儿童脓毒症病原学的诊断效能。方法：前瞻性纳入2019年3月至2020年12月江门市妇幼保健院PICU收治的脓毒症患儿，采集其血液标本进行血培养及mNGS同步检测。以儿童序贯器官功能障碍评分(pSOFA)作为儿童脓毒症临床诊断标准，应用Kappa评价方法对临床诊断标准、血培养结果、mNGS结果进行诊断一致性分析。以临床诊断标准为“金标准”，计算血培养与mNGS的敏感度、特异度、阳性预测值、阴性预测值、准确度及Youden指数，以评估比较两者的诊断效能。结果：行血培养及mNGS同步检测的62例脓毒症患儿中，中位年龄为17个月，婴幼儿占85.5%；pSOFA评分≥2分共40例，占64.5%，感染灶以呼吸系统为主。血培养与mNGS具有诊断一致性，同时差异具有统计学意义(P<0.05)。临床诊断标准与血培养、mNGS结果的Kappa值均为0.745，具有诊断一致性。在40例符合临床诊断标准的患儿中，其中18例血培养及mNGS结果均为阳性且病原体一致，17例血培养阴性而mNGS结果阳性。血培养与mNGS的敏感度分别为45%、87.5%，特异度为68.1%、72.7%，阳性预测值为72%、85.4%，阴性预测值为40.5%、76.2%，准确性为52.3%、83.8%，约登指数分别为0.131、0.62。结论：在儿童脓毒症病原学诊断中，mNGS的诊断效能优于血培养，可作为病原学诊断技术的必要补充。

Objective: To investigate the diagnostic efficacy of metagenomic next-generation sequencing in the etiology of children with sepsis.Methods: From March 2019 to December 2020,a prospective study was conducted on the patients with sepsis at Pediatric Intensive Care Unit,Jiangmen Maternity and Child Health Care Hospital.The patients'blood samples were collected to perform blood culture and mNGS simultaneously.The pSOFA score was used for the clinical diagnosis.Kappa was used to evaluate the consistency of blood culture and mNGS.The clinical diagnosis was taken as the"gold standard".The sensitivity,specificity,positive predictive value,negative predictive value,accuracy,Youden index were calculated,to assess the diagnostic efficacy between the two methods.Results: Sixty-two patients were enrolled and simultaneously tests of sequencing were performed.Among 62 patients,the median age was 17 months,85.5% of whom were infants.40 cases had a pSOFA score ≥ 2,respiratory system was mostly involved.Blood culture was consistent with mNGS,and the difference was statistically significant (P<0.05).The Kappa value of the clinical diagnostic of sepsis,blood culture and mNGS were 0.745,indicating a consistent diagnosis.Among the 40 cases with clinical diagnosis,18 cases were positive in blood culture and mNGS had the same pathogen,and 17 cases were negative in blood culture but positive in mNGS.The sensitivity of were 45% and 87.5%,the specificity were 68.1% and 72.7%,the positive predictive value were 72% and 85.4%,the negative predictive value were 40.5% and 76.2%,the accuracy were 52.3% and 83.8%,and the Youden index were 0.131 and 0.62,respectively for blood culture and mNGS.Conclusion: The method of mNGS has a better diagnostic efficacy than blood culture in the etiology of children with sepsis.mNGS could be used as a necessary complement to the etiological diagnosis technology.

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