宏基因二代测序技术对非结核分枝杆菌感染病原学诊断的价值

目的:探讨宏基因二代测序(metagenomic next-generation sequencing,mNGS)技术对非结核分枝杆菌(non-tuberculosis mycobacteria,NTM)感染病原学诊断的价值。方法:回顾性选取2018年9月至2019年12月复旦大学附属中山医院感染病科收治的疑似NTM感染患者183例,共计样本388例,比较常规微生物培养法和mNGS技术对NTM病原体的检出率差异及不同样本类型的亚组分析。结果:常规微生物培养法和mNGS总体检测阳性率差异无统计学意义(21.9%vs 24.7%)。痰液样本培养法的阳性率明显高于mNGS(56.6%vs 22.9%,P0.000 1),而组织样本却低于mNGS(7.8%vs 27.8%,P0.000 1)。另外,mNGS对患者抗菌药物调整频率低于培养法(20.3%vs 40.2%,P0.05)。结论:mNGS对NTM灵敏度较低,需重点改进以促进此技术更好地应用于临床。

Etiological diagnostic value of metagenomic next-generation sequencing in non-tuberculous mycobacteria infection

Objective: To explore the value of metagenomic next-generation sequencing (mNGS) in etiological diagnosis of patients with non-tuberculosis mycobacterium (NTM) infection. Methods: A total of 183 NTM infected patients admitted to the Department of Infectious Diseases of Zhongshan Hospital, Fudan University from September 2018 to December 2019 were selected retrospectively, and a total of 388 samples were collected. The differences in the detection rate of NTM pathogens were analyzed by conventional microbial culture method and mNGS technology and the subgroup analysis of different sample types were performed. Results: There was no significant difference of positive rate between culture method and mNGS (21.9% vs 24.7%). Positive rate of sputum was significantly higher detected by culture method than that by mNGS (56.6% vs 22.9%,P<0.000 1), whereas for tissue type, positive rate is lower using culture method than that using mNGS (7.8% vs 27.8%,P<0.000 1). In addition, positive result of mNGS decreased frequency of antimicrobial modulation compared with culture method. Conclusions: mNGS is a promising technique, but the sensitivity of NTM is low, it is necessary to improve this technology to make it better applied in clinic.