[用于鉴定重型再生障碍性贫血血流感染病原体的血浆宏基因组下一代测序]
[Metagenomic next-generation sequencing of plasma for the identification of bloodstream infectious pathogens in severe aplastic anemia].
作者信息
Li Y, Xiong Y Z, Fan H H, Jing L P, Li J P, Lin Q S, Xu C H, Li Y, Ye L, Jiao M, Yang Y, Li Y, Yang W R, Peng G X, Zhou K, Zhao X, Zhang L, Zhang F K
机构信息
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China.
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China Microbiology Laboratory Tianjin Union Precision Medical Diagnostic Co., Ltd, Tianjin 301617, China.
出版信息
Zhonghua Xue Ye Xue Za Zhi. 2023 Mar 14;44(3):236-241. doi: 10.3760/cma.j.issn.0253-2727.2023.03.010.
To analyze the diagnostic value of cell-free plasma metagenomic next-generation sequencing (mNGS) pathogen identification for severe aplastic anemia (SAA) bloodstream infection. From February 2021 to February 2022, mNGS and conventional detection methods (blood culture, etc.) were used to detect 33 samples from 29 consecutive AA patients admitted to the Anemia Diagnosis and Treatment Center of the Hematology Hospital of the Chinese Academy of Medical Sciences to assess the diagnostic consistency of mNGS and conventional detection, as well as the impact on clinical treatment benefits and clinical accuracy. ①Among the 33 samples evaluated by mNGS and conventional detection methods, 25 cases (75.76%) carried potential pathogenic microorganisms. A total of 72 pathogenic microorganisms were identified from all cases, of which 65 (90.28%) were detected only by mNGS. ②All 33 cases were evaluated for diagnostic consistency, of which 2 cases (6.06%) were Composite, 18 cases (54.55%) were mNGS only, 2 cases (6.06%) were Conventional method only, 1 case (3.03%) was both common compliances (mNGS/Conventional testing) , and 10 cases (30.3%) were completely non-conforming (None) . ③All 33 cases were evaluated for clinical treatment benefit. Among them, 8 cases (24.24%) received Initiation of targeted treatment, 1 case (3.03%) received Treatment de-escalation, 13 cases (39.39%) received Confirmation, and the remaining 11 cases (33.33%) received No clinical benefit. ④ The sensitivity of 80.77%, specificity of 70.00%, positive predictive value of 63.64%, negative predictive value of 84.85%, positive likelihood ratio of 2.692, and negative likelihood ratio of 0.275 distinguished mNGS from conventional detection methods (21/12 5/28, <0.001) . mNGS can not only contribute to accurately diagnosing bloodstream infection in patients with aplastic anemia, but can also help to guide accurate anti-infection treatment, and the clinical accuracy is high.
分析游离血浆宏基因组下一代测序（mNGS）病原体鉴定对重型再生障碍性贫血（SAA）血流感染的诊断价值。2021年2月至2022年2月，采用mNGS和传统检测方法（血培养等）对中国医学科学院血液病医院贫血诊疗中心收治的29例连续性AA患者的33份样本进行检测，评估mNGS与传统检测的诊断一致性，以及对临床治疗获益和临床准确性的影响。①在采用mNGS和传统检测方法评估的33份样本中，25例（75.76%）携带潜在致病微生物。所有病例共鉴定出72种致病微生物，其中65种（90.28%）仅通过mNGS检测到。②对所有33例病例进行诊断一致性评估，其中2例（6.06%）为复合情况，18例（54.55%）仅为mNGS，2例（6.06%）仅为传统方法，1例（3.03%）为两种方法均符合（mNGS/传统检测），10例（30.3%）完全不符合（均不符合）。③对所有33例病例进行临床治疗获益评估。其中，8例（24.24%）开始靶向治疗，1例（3.03%）降低治疗强度，13例（39.39%）得到确认，其余11例（33.33%）未获得临床获益。④mNGS与传统检测方法相比，灵敏度为80.77%，特异度为70.00%，阳性预测值为63.64%，阴性预测值为84.85%，阳性似然比为2.692，阴性似然比为0.275（21/12 5/28，<0.001）。mNGS不仅有助于准确诊断再生障碍性贫血患者的血流感染，还能帮助指导精准抗感染治疗，临床准确性高。
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