Department of Rheumatology and Immunology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
Br J Hosp Med (Lond). 2024 Jul 30;85(7):1-16. doi: 10.12968/hmed.2024.0121.
Adult-onset Still's disease (AOSD) shares similar clinical symptoms with sepsis. Thus, differentiating between AOSD and sepsis presents a great challenge while making diagnosis. This study aimed to analyse the changes in blood microbiota related to AOSD and sepsis using metagenomic next-generation sequencing (mNGS), identify potential biomarkers that distinguish AOSD from sepsis, and explore the diagnostic value of mNGS in differentiation between these two pathological conditions. Clinical data of four AOSD patients and four sepsis patients treated in the Department of Rheumatology and Immunology, The Affiliated Hospital of Xuzhou Medical University between October 2021 and February 2022 were collected. The mNGS diagnostic records of these patients were analysed for microbial correlations in terms of species taxonomic structure and beta diversity by comparing blood microbiota between AOSD and sepsis. The biomarkers with the strongest capability in distinguishing the subgroups were screened using a random forest algorithm. There was no statistically significant differences between AOSD patients and sepsis controls in terms of gender and age ( > 0.05). A total of 91 operational taxonomic units (OTUs) were obtained. At the level of phylum, , and were present in high abundances in both groups (79.76%, 14.18% and 3.30% vs 54.03%, 32.77% and 5.81%). At the genus level, the abundances of , and were the top three highest in the AOSD group (73.88%, 10.92% and 5.48%), while , and were ranked as the top three in the sepsis group in term of abundance (48.69%, 27.36% and 5.52%). In beta-diversity analysis, there were advances shown in visual principal coordinates analysis (PCoA) and non-metric multidimensional scaling (NMDS) between the AOSD group and sepsis group ( < 0.05), with little significant differences in the analysis of similarities (Anosim) ( > 0.05). Linear discriminant analysis effect size (LEfSe) showed that , , , , , , , , , , , and were more enriched in sepsis group ( < 0.05). The top five variables with the strongest capability in distinguishing between AOSD and sepsis were , , , and . The blood microorganisms in AOSD were different from sepsis, and mNGS was potential to distinguish between AOSD and sepsis.
成人斯蒂尔病（AOSD）与脓毒症具有相似的临床症状。因此，在诊断时，区分 AOSD 和脓毒症具有很大的挑战性。本研究旨在通过宏基因组下一代测序（mNGS）分析与 AOSD 和脓毒症相关的血液微生物群的变化，确定区分 AOSD 和脓毒症的潜在生物标志物，并探讨 mNGS 在区分这两种病理状况中的诊断价值。 收集了 2021 年 10 月至 2022 年 2 月在徐州医科大学附属医院风湿免疫科治疗的 4 例 AOSD 患者和 4 例脓毒症患者的临床资料。通过比较 AOSD 和脓毒症患者的血液微生物群，从物种分类结构和β多样性方面分析 mNGS 诊断记录中与微生物相关的信息。使用随机森林算法筛选区分亚组能力最强的生物标志物。 AOSD 患者和脓毒症对照组在性别和年龄方面无统计学差异（>0.05）。共获得 91 个操作分类单元（OTUs）。在门水平上，两组中均存在高丰度的 、 和 （79.76%、14.18%和 3.30%比 54.03%、32.77%和 5.81%）。在属水平上，AOSD 组中丰度最高的前三种菌属为 、 和 （73.88%、10.92%和 5.48%），而脓毒症组中丰度最高的前三种菌属为 、 和 （48.69%、27.36%和 5.52%）。在β多样性分析中，AOSD 组和脓毒症组在可视主坐标分析（PCoA）和非度量多维尺度分析（NMDS）中表现出明显差异（<0.05），相似性分析（Anosim）（>0.05）无显著差异。线性判别分析效应量（LEfSe）显示， 、 、 、 、 、 、 、 、 、 和 在脓毒症组中更为丰富（<0.05）。区分 AOSD 和脓毒症能力最强的前五个变量为 、 、 、 和 。 AOSD 的血液微生物与脓毒症不同，mNGS 有可能区分 AOSD 和脓毒症。
