宏基因组二代测序在血液病合并感染中的临床应用及检出率影响因素分析

Clinical Application of Metagenomic Next-Generation Sequencing in Patients with Infected Hematological Diseases and Analysis of Factors Influencing the Detection Rate

摘要: 探究本中心血液病合并感染患者中，宏基因组二代测序(metagenomic next-generation sequencing, mNGS)的临床诊断价值及其检出率影响因素。通过对2022年1月至2022年10月期间于本中心血液内科就诊的血液病患者的临床资料进行回顾性分析，分析外周血mNGS检出病原谱分布情况、与传统检测技术病原体检出率的差异，探讨mNGS检测致病病原菌的临床诊断价值。研究发现外周血mNGS阳性率为74.86% (137/183)，显著高于传统检查阳性率20.22% (37/183)，和血培养阳性率(10.93%, P < 0.001)，单独检出病毒、细菌和真菌病原体分别占38.7%、11.70%和5.80%。外周血mNGS阳性标本中临床认可率为62.04% (85例)，其中51.76% (44例)患者经治疗后症状好转。年龄增长、白细胞升高、hs-CRP升高、合并肺部感染、合并低蛋白血症、合并骨髓抑制是血液病合并感染患者mNGS病原体检出阳性的独立影响因素。外周血mNGS在血液病合并感染患者病原检出方面具有较高的阳性率、临床认可率，可有效指导临床治疗。

Abstract: To explore the clinical diagnostic value of metagenomic next-generation sequencing (mNGS) in patients with hematological diseases complicated with infections in our center and the factors influencing its detection rate. A retrospective analysis was conducted on the clinical data of hematological patients who visited the hematology department of our center from January 2022 to October 2022. The study aimed to analyze the distribution of pathogens detected by peripheral blood mNGS, compare the detection rates of pathogens between mNGS and conventional diagnostic techniques, and explore the clinical diagnostic value of mNGS in identifying pathogenic microorganisms. The results showed that the positive rate of peripheral blood mNGS was 74.86% (137 out of 183 cases), which was significantly higher than that of conventional tests at 20.22% (37 out of 183 cases) and blood culture at 10.93% (P < 0.001). The detection rates of viral, bacterial, and fungal pathogens by mNGS alone were 38.7%, 11.70%, and 5.80%, respectively. Among the mNGS-positive samples, the clinical acceptance rate was 62.04% (85 cases), with 51.76% (44 cases) of patients showing symptom improvement after targeted treatment. Factors such as increasing age, elevated white blood cell count, increased hs-CRP levels, concurrent pulmonary infection, hypoalbuminemia, and bone marrow suppression were identified as independent predictors of positive mNGS results in patients with hematological diseases and infections. Peripheral blood mNGS demonstrated high positivity and clinical acceptance rates in detecting pathogens in patients with hematological diseases and infections, effectively guiding clinical treatment.