病原靶向二代测序(t-NGS)在重症患者中的病原学诊断应用研究

Application of Pathogen Targeted Second-Generation Sequencing(t-NGS)in Pathogen Diagnosis of Critically ill Patients

李婷 ¹何铭辉 ²林钊 ²赖炳权 ²李中鹏 ³何志捷³

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作者信息

1. 中山大学附属第五医院超声科(519000)
2. 广州永诺医学检验所有限公司
3. 中山大学孙逸仙纪念医院重症医学科
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摘要

目的:探讨病原靶向二代测序(t-NGS)在重症患者中的病原学诊断应用价值.方法:对70例疑似感染的重症患者进行宏基因二代测序、病原靶向二代测序以及传统病原学培养,并且与复合临床诊断相比,评估其对重症感染患者的诊断效果.结果:在病原体检出方面,m-NGS病原体检出率明显高于t-NGS与传统病原学培养(55.71%vs 52.86%vs 21.43%,P<0.001).在诊断效能方面,以临床复合诊断为参考,t-NGS的灵敏度为81.82%,特异度为89.19%,阴性预测值为84.62%,阳性预测值为87.10%,AUC值为0.855(95%CI:0.785-0.952);m-NGS灵敏度为 90.91%,特异度为 89.19%,阴性预测值为 91.67%,阳性预测值为 88.24%,AUC值为 0.900(95%CI:0.819-0.982),t-NGS诊断效能与m-NGS差异无统计学意义(P>0.05).病原学培养的灵敏度为42.42%,特异度为97.30%,阴性预测值为65.45%,阳性预测值为93.33%,AUC值为0.699(95%CI:0.572-0.826),t-NGS与病原学培养差异具有统计学意义(P<0.001).结论:与传统病原学培养相比,t-NGS在ICU中疑似感染的重症患者诊断效能上更具优势,与m-NGS诊断效能无统计学差异.

Abstract

Objective:To evaluate the diagnostic utility of pathogen-targeted next-generation sequencing(t-NGS)for pathogen detection in critically ill patients.Methods:Seventy critically ill patients with suspected infections underwent metagenomic next-generation sequencing(m-NGS),pathogen-targeted next-generation sequencing(t-NGS),and traditional microbiological culture.The diagnostic performance of these methods was assessed against a composite clinical diagnosis.Results:In pathogen detection,m-NGS showed the highest detection rate(55.71%),followed by t-NGS(52.86%)and traditional culture(21.43%)(P<0.001).For diagnostic efficacy,t-NGS achieved a sensitivity of 81.82%,specificity of 89.19%,negative predictive value(NPV)of 84.62%,positive predictive value(PPV)of 87.10%,and an area under the curve(AUC)of 0.855(95%CI:0.785-0.952).m-NGS demonstrated a sensitivity of 90.91%,specificity of 89.19%,NPV of 91.67%,PPV of 88.24%,and an AUC of 0.900(95%CI:0.819-0.982).There was no statistically significant difference in diagnostic efficacy between t-NGS and m-NGS(P>0.05).Traditional culture,by comparison,had a sensitivity of 42.42%,specificity of 97.30%,NPV of 65.45%,PPV of 93.33%,and an AUC of 0.699(95%CI:0.572-0.826).The diagnostic efficacy of t-NGS was significantly superior to traditional culture(P<0.001),though the detection cycle of t-NGS was longer than that of m-NGS.Conclusion:Pathogen-targeted next-generation sequencing offers significant advantages over traditional culture in diagnosing infections in ICU patients.Its diagnostic performance is comparable to metagenomic next-generation sequencing,making it a valuable tool for pathogen identification in critically ill populations.

关键词

重症监护病房/感染性疾病/宏基因二代测序/病原靶向二代测序

Key words

intensive care unit/infectious diseases/metagenomic next-generation sequencing/pathogen targeted next-generation sequencing

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出版年

2024

岭南急诊医学杂志

广东省医学会

岭南急诊医学杂志

影响因子：0.437

ISSN：1671-301X

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