Cai Zhen, Zhang Xian, Song Yaqin, Jiang Yan, Jiang Ling, Li Tao, Sun Xufang
Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China.
Xiangyang Hospital affiliated to Hubei University of Chinese Medicine, Xiangyang, PR China.
J Med Microbiol. 2024 Dec;73(12). doi: 10.1099/jmm.0.001879.
Diagnosis of uveitis is challenging due to the multitude of possible pathogenies. Identifying infectious and non-infectious uveitis is of great clinical significance. Recently, metagenomic next-generation sequencing (mNGS) was used to detect infectious and non-infectious uveitis, but its efficacy has not been widely evaluated. Compared with routine diagnostic tests (RDTs), mNGS is more effective in identifying infectious and non-infectious uveitis. To describe the microbiological diagnostic performance of mNGS in detecting infectious and non-infectious uveitis. Patients with suspected infectious uveitis of uncertain pathogenesis were tested by mNGS and RDTs. Infectious and non-infectious uveitis were grouped according to the final diagnosis based on comprehensive analysis of the test results and the effect of therapy. The test results were used to assess the performance of mNGS in actual clinical practice. Fifty-eight cases were enrolled in this project, including 32 cases of infectious uveitis and 26 cases of non-infectious uveitis. The sensitivity of mNGS was 96.88%, which was much higher than that of RDTs. The detected pathogenic micro-organisms included bacteria, fungi, viruses, and . Consequently, mNGS showed a high negative predictive value (NPV) of 94.74%, indicating that an mNGS negative should be a true negative result most of the time, but a low positive predictive value (PPV) of 79.49%. mNGS showed extremely high sensitivity but low specificity, which increased the detection rate of infectious uveitis pathogens but might result in false positives. The excellent NPV suggested that the identification of non-infectious uveitis is of considerable clinical importance.
由于可能的致病原因众多，葡萄膜炎的诊断具有挑战性。区分感染性和非感染性葡萄膜炎具有重要的临床意义。最近，宏基因组下一代测序（mNGS）被用于检测感染性和非感染性葡萄膜炎，但其效果尚未得到广泛评估。与常规诊断测试（RDTs）相比，mNGS在识别感染性和非感染性葡萄膜炎方面更有效。为了描述mNGS在检测感染性和非感染性葡萄膜炎中的微生物诊断性能。对疑似病因不明的感染性葡萄膜炎患者进行了mNGS和RDTs检测。根据对检测结果和治疗效果的综合分析，基于最终诊断将感染性和非感染性葡萄膜炎进行分组。检测结果用于评估mNGS在实际临床实践中的性能。本项目共纳入58例患者，其中感染性葡萄膜炎32例，非感染性葡萄膜炎26例。mNGS的敏感性为96.88%，远高于RDTs。检测到的致病微生物包括细菌、真菌、病毒等。因此，mNGS显示出较高的阴性预测值（NPV），为94.74%，表明mNGS阴性大多情况下应为真阴性结果，但阳性预测值（PPV）较低，为79.49%。mNGS显示出极高的敏感性但特异性较低，这提高了感染性葡萄膜炎病原体的检出率，但可能导致假阳性。出色的NPV表明非感染性葡萄膜炎的鉴别具有相当重要的临床意义。
