中国实用内科杂志2024，Vol.44Issue(4)：316-320,5.DOI:10.19538/j.nk2024040110
宏基因组高通量测序诊断血液病患者侵袭性真菌病研究
Study on the diagnosis of invasive mycosis in patients with hematological diseases by metagenomics next generation sequencing
摘要
Abstract
Objective To evaluate the clinical characteristics and related risk factors of invasive fungal disease(IFD)in patientswith blood diseases diagnosed by high-throughput metagenomic sequencing(mNGS).Methods From January 2022 to January 2023,70 hospitalized patients with blood diseases who were suspected of infection with IFD underwent mNGS and fungal pathogen detection.The clinical characteristics and laboratory data of 32 fungal infected individuals(IFD group)and 38 non IFD groups were compared.Results In the IFD group,15 cases(47％)of Candida,6 cases(19％)of Aspergillus,4 cases(12.5％)of Rhizopus,4 cases(12.5％)of Spores,and 3 other cases(9％)were detected by mNGS.Out of 36 blood samples,11(30.6％)were positive by mNGS;However,there were only 3 cases(8.3％)of fungal microbial culture,with a significant difference in positive detection rate(P=0.017).Using traditional fungal culture results as the"gold standard",the sensitivity,specificity,positive predictive value,and negative predictive value of mNGS for evaluating fungal infection in hematological patients were calculated,and the results were 100％(10/10),63.3％(38/60),31.3％(10/32),and 100％(38/38),respectively.After multiple logistic regression analysis,the risk factors associated with IFD were:CD4+cell count below 400 cells/μL[OR 7.43,95％CI 7.43(2.46-22.44),P＜0.001],increased level of C-reactive protein[OR 3.71,95％CI 3.71(1.33-10.32),P=0.01],IL-6[OR 6.5,95％CI6.50(2.27-18.62),P＜0.001]and IL-10[OR 3.03,95％CI 3.03(1.03-8.94),P=0.041],hypoalbuminemia[OR 7.04,95％CI 7.04(1.40-35.56),P=0.025]and sustained neutropenia lasting for more than 10 days[OR 3.03,95％CI 3.03(1.03-8.94),P=0.002].Conclusion mNGS has high sensitivity in detecting IFD in patients with hematological diseases.CD4+cell count below 400/μL,increased level of C-reactive protein,IL-6,and IL-10,hypoalbuminemia,and neutropenia lasting for more than 10 days are independent risk factors for IFD in patients with hematological diseases.关键词
血液病/侵袭性真菌病/宏基因组高通量测序/风险因素Key words
hematological diseases/invasive fungal diseases/mNGS/risk factors分类
医药卫生引用本文复制引用
陈曦,王纬,连芸,郑林依,宋玉华,刘晓庆,龙启强,宫跃敏..宏基因组高通量测序诊断血液病患者侵袭性真菌病研究[J].中国实用内科杂志,2024,44(4):316-320,5.基金项目
国家自然科学基金(81900109) （81900109）
