标题：宏基因检测在中枢神经系统感染性疾病诊断中的作用

      作者：简洪彬，叶云霞，邱卓贤，赖观炜    新兴县人民医院神经内科，广东 新兴 527400

      卷次： 2024年35卷8期

      【摘要】 目的 探究宏基因检测(mNGS)在中枢神经系统感染性疾病诊断中的作用。方法 回顾性分析新兴县人民医院于2022年7月至2023年9月收治的20例疑似中枢神经系统感染患者的病历资料，收集脑脊液mNGS检测报告结果、脑脊液微生物培养及病原学等检查结果进行分析。结果 20例患者中 13例确诊为中枢神经系统感染，7例排除中枢神经系统感染。脑脊液mNGS结果中，6例脑脊液mNGS报告结果呈阴性，14例检出可疑的致病病原体或特异序列，其中8例检出细菌(结核分枝杆菌4例、金黄色葡萄球菌2例，肺炎克雷伯菌1例，链球菌属1例)，5例检出病毒(水痘-带状疱疹病毒2例，EB病毒2例，巨细胞病毒1例)，1例检出真菌(白色念珠菌)。mNGS与脑脊液微生物培养的特异度、阳性及阴性预测值均相当，差异无统计学意义(P>0.05)。mNGS诊断中枢神经系统感染性疾病的敏感度和准确度分别为76.92%、75.00%，明显高于脑脊液微生物培养的30.77%、35.00%，差异均有统计学意义(P<0.05)。结论 相对于脑脊液微生物培养，mNGS在中枢神经系统感染性疾病中诊断的准确率较高，但其检出结果与最终诊断结果仍存在较大偏差。因此，对于中枢神经系统感染性疾病的临床诊断应结合mNGS、脑脊液微生物培养等多种检验方法进行综合判断，以达到早期诊断，精准治疗的目的。
      【关键词】 中枢神经系统感染；脑脊液；宏基因检测；病原体
      【中图分类号】 R741 【文献标识码】 A 【文章编号】 1003—6350（2024）08—1136—04

Role of metagenomics next generation sequencing in the diagnosis of infectious diseases of central nervous system.JIAN Hong-bin, YE Yun-xia, QIU Zhuo-xian, LAI Guan-wei.
Department of Neurology, Xinxing County People's Hospital,Xinxing 527400, Guangdong, CHINA
【Abstract】 Objective To explore the role of metagenomics next generation sequencing (mNGS) in the diagno-sis of infectious diseases of central nervous system. Methods The medical records of 20 patients with suspected centralnervous system infection in Xinxing County People's Hospital from July 2022 to September 2023 were selected as the re-search objects. The results of mNGS test report, microbial culture, and etiology of cerebrospinal fluid were collected andanalyzed. Results Among the 20 patients, 13 were diagnosed as central nervous system infection, and 7 were excludedfrom central nervous system infection. In the results of cerebrospinal fluid mNGS, 6 patients were negative, and 14 pa-tients were found to have specific sequences or suspected pathogenic pathogens, among which 8 cases were found tobe bacteria (4 cases of Mycobacterium tuberculosis, 2 cases of Staphylococcus aureus, 1 case of Klebsiella pneumoniae, and1 case of Streptococcus), 5 cases were found to be viruses (2 cases of varicella-zoster virus, 2 cases of EB virus and 1 caseof cytomegalovirus) and 1 case was found to be fungi (Candida albicans). There was no significant difference in specific-ity, positive predictive value, and negative predictive value between mNGS and CSF microbial culture, and the differenc-es were not statistically significant (P>0.05). The sensitivity and accuracy of mNGS in the diagnosis of central nervoussystem infectious diseases were 76.92% and 75.00%, which were significantly higher than 30.77% and 35.00% in cere-brospinal fluid microbial culture (P<0.05). Conclusion Compared with microbial culture of cerebrospinal fluid,mNGS has a higher accuracy in the diagnosis of central nervous system infectious diseases, but there is still a large devia-tion between the detection results and the final diagnosis results. Therefore, the clinical diagnosis of central nervous sys-tem infectious diseases should be made by combing mNGS with microbial culture of cerebrospinal fluid and other testmethods, in order to achieve the purpose of early diagnosis and accurate treatment.
      【Key words】 Central nervous system infection; Cerebrospinal fluid; Metagenomics next generation sequencing;Pathogen