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| 中枢神经系统感染不同指标诊断价值 |
| Diagnostic value of different indicators for central nervous system infection |
| 投稿时间：2025-06-19 |
| DOI：10.3969/j.issn.1000-0399.2026.01.003 |
| 中文关键词: 宏基因组二代测序 中枢神经系统感染 脑脊液检测 诊断 |
| 英文关键词: Metagenomic next-generation sequencing Central nervous system infections Cerebrospinal fluid testing Diagnosis |
| 基金项目:安徽省卫生健康科研项目(编号:AHWJ2023A20346) |
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| 中文摘要: |
| 目的 探讨宏基因组二代测序（mNGS）和脑脊液（CSF）常规、培养在中枢神经系统（CNS）感染诊断中的价值。方法 回顾性分析2022年12月至2024年10月中国科学技术大学附属第一医院（安徽省立医院）与皖南医学院附属太和医院收治的107例疑似CNS感染住院患者临床资料，均行CSF常规与mNGS检测。CNS感染根据临床表现、CSF结果及影像/病原学证据综合判定；以此分为感染组（69例）与非感染组（38例），比较两组患者基线资料、CSF检查结果等。多因素logistic回归仅纳入诊断相关指标筛选独立因素，受试者工作特征（ROC）曲线评估单个指标诊断效能，并确定最佳截断值并计算灵敏度、特异度、似然比及准确度；采用DeLong法比较曲线下面积（AUC）。结果 mNGS阳性例数高于CSF培养（58例比8例），报告时间短于CSF培养（24 h比72～120 h）。单因素分析结果显示，与非感染组相比，感染组住院费用、住院时间、入住重症监护室（ICU）率、mNGS阳性率、CSF外观浑浊率、白细胞计数和总蛋白水平更高，而葡萄糖、氯离子水平更低（P<0.05）。Logistic回归分析结果显示，mNGS阳性（OR=11.511,95%CI:3.225～31.092）、CSF白细胞计数（OR=1.169,95%CI:1.081～1.264）、CSF总蛋白（OR=1.822,95%CI:1.110～2.992）及CSF外观浑浊（OR=4.656,95%CI:1.843～11.763）为CNS感染独立危险因素；CSF葡萄糖为保护因素（OR=0.514,95%CI:0.300～0.880）(P<0.05)。ROC曲线分析结果显示，CSF白细胞计数诊断效能最佳（AUC=0.974,95%CI:0.937～0.995），灵敏度83.8%、特异度89.3%，最佳截断值为20×106/L;DeLong检验提示其AUC高于其他因素（P<0.001）。结论 mNGS较培养具更快时效与更高检出率，联合CSF常规等检查或可改善CNS感染的诊疗过程。 |
| 英文摘要: |
| Objective To investigate the diagnostic value of metagenomic next-generation sequencing(mNGS) and routine cerebrospinal fluid(CSF) tests in central nervous system(CNS) infection. Methods We retrospectively analyzed the clinical data of 107 hospitalized patients with suspected CNS infection admitted between December 2022 and October 2024 to the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital) and Taihe Hospital Affiliated to Wannan Medical College. All patients underwent routine CSF testing and mNGS. CNS infection was comprehensively determined based on clinical manifestations, CSF findings, and imaging/microbiological evidence. Patients were divided into an infection group(n=69) and a non-infection group(n=38). Baseline characteristics and CSF test results were compared between groups. Multivariable logistic regression included only diagnosis-related indicators to identify independent factors. Receiver operating characteristic(ROC) curves were used to evaluate the diagnostic performance of individual indicators, and the optimal cutoff value was determined to calculate sensitivity, specificity, likelihood ratios, and accuracy. AUCs were compared using De Long's test. Results The number of m NGS-positive cases was higher than that of culture(58 cases vs. 8 cases), and the reporting time was shorter than culture(24 h vs. 72～120 h). Univariate analysis showed that, compared with the non-infection group, the infection group had higher hospitaliza-tion cost, longer length of stay, higher intensive care unit(ICU) admission rate, higher m NGS positivity rate, higher proportion of turbid CSF, higher CSF leukocyte count, and higher CSF total protein, whereas CSF glucose and chloride levels were lower(P<0.05). Logistic regression showed that m NGS positivity(OR=11.511, 95% CI: 3.225～31.092), CSF leukocyte count(OR=1.169, 95% CI: 1.081～1.264), CSF total protein(OR=1.822, 95% CI: 1.110～2.992), and turbid CSF appearance(OR=4.656, 95% CI: 1.843～11.763) were independent risk factors for CNS in-fection, while CSF glucose was a protective factor(OR=0.514, 95% CI: 0.300～0.880)(P<0.05). ROC analysis showed that CSF leukocyte count had the best diagnostic performance(AUC=0.974, 95% CI: 0.937～0.995), with a sensitivity of 83.8% and a specificity of 89.3%, and an opti-mal cutoff value of 20×106/L. De Long's test indicated that its AUC was higher than that of the other factors(P<0.05). Conclusion Compared with culture, m NGS has a shorter turnaround time and a higher detection yield. Combining m NGS with routine CSF tests may improve the diag-nostic and therapeutic process for CNS infection. |
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