β-D-葡聚糖检测和下一代宏基因组测序在真菌性眼内炎诊断中的临床价值。

THE CLINICAL VALUE OF β-D-GLUCAN TESTING AND NEXT-GENERATION METAGENOMIC SEQUENCING FOR THE DIAGNOSIS OF FUNGAL ENDOPHTHALMITIS.

机构信息

Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.

Joint Laboratory of Drug Delivery & Innovative Therapy Built By Beijing Chaoyang Hospital & State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing, China.

出版信息

Retina. 2024 Jul 1;44(7):1209-1216. doi: 10.1097/IAE.0000000000004073.

DOI:10.1097/IAE.0000000000004073

PMID:38359396

Abstract

PURPOSE

To explore the clinical value of β-D-glucan (BDG) testing and metagenomic next-generation sequencing (mNGS) for detecting the pathogens of fungal endophthalmitis (FE).

METHODS

This study included 32 cases (32 eyes) with FE and 20 cases (20 eyes) with intraocular inflammation caused by other etiologies. All patients underwent extraction of aqueous humor or vitreous fluid samples for BDG testing and mNGS. The diagnostic performance and total clinical concordance rate of BDG testing and mNGS for FE were evaluated and calculated based on the results of the clinical diagnosis.

RESULTS

Among the clinically diagnosed FE, the positivity rates of BDG testing and mNGS (90.63%) were both significantly higher ( P < 0.001) than that of microbial cultures (53.13%). There was 100% consistency in pathogen identification using mNGS and culture identification for culture-positive cases. The area under the curve was 0.927 for BDG testing and 0.853 for mNGS. When the two tests were combined, sensitivity (93.75%), specificity (100.00%), and total clinical concordance rate (96.15%) were all improved, compared with the single tests.

CONCLUSION

The positive rates of BDG test and mNGS were markedly higher than those of cultures in FE identification. The combination of these two tests showed improved performance when compared with individual tests.

摘要

目的

探讨β-D-葡聚糖（BDG）检测和宏基因组下一代测序（mNGS）在真菌性眼内炎（FE）病原体检测中的临床价值。

方法

本研究纳入了 32 例（32 只眼）FE 患者和 20 例（20 只眼）其他病因引起的眼内炎症患者。所有患者均接受了房水或玻璃体样本提取，用于 BDG 检测和 mNGS。根据临床诊断结果，评估并计算了 BDG 检测和 mNGS 对 FE 的诊断性能和总临床符合率。

结果

在临床诊断为 FE 的患者中，BDG 检测和 mNGS 的阳性率（90.63%）均明显高于微生物培养（53.13%）（P<0.001）。对于培养阳性病例，mNGS 和培养鉴定的病原体鉴定一致性为 100%。BDG 检测的曲线下面积为 0.927，mNGS 为 0.853。当两种检测方法联合使用时，与单一检测相比，敏感性（93.75%）、特异性（100.00%）和总临床符合率（96.15%）均得到提高。