【摘要】 目的探究高通量测序技术(HTS)对重症脓毒症患者的病原学诊断价值。方法选取122例重症脓毒症患者,随机分为研究组(62例)和对照组(60例)。研究组患者采用血培养(BC)联合HTS检测,对照组患者采用BC检测。两组患者均接受经验性抗感染治疗。统计病原学诊断结果及类型,并比较两组病原学诊断阳性率、病毒诊断阳性率;比较两组接受经验性抗感染治疗后诊断阳性率、重症监护病房(ICU)住院时间、28 d生存率、并发症发生情况。结果研究组62例患者中58例患者病原学诊断结果阳性,对照组60例患者中24例患者病原学诊断结果阳性。研究组患者病原学诊断阳性率93.55%(58/62)高于对照组的40.00%(24/60),病毒诊断阳性率20.97%(13/62)高于对照组的0(0/60),差异均有统计学意义(χ~2=39.675、14.081, P<0.05)。接受经验性抗感染治疗后,研究组诊断阳性率为32.26%,高于对照组的15.00%,差异有统计学意义(χ~2=5.012, P<0.05);两组并发症发生率比较差异无统计学意义(P>0.05)。研究组ICU住院时间(10.04±2.06)d短于对照组的(18.25±2.87)d, 28 d生存率85.48%高于对照组的56.67%,差异有统计学意义(P<0.05)。结论 HTS检测范围广,能够提高对重症脓毒症患者病原微生物的诊断阳性率,为重症脓毒症患者抗感染方案的选择提供方向,以避免盲目使用抗生素,缩短ICU住院时间,提高生存率。更多还原

【Abstract】 Objective To investigate the value of high-throughput sequencing(HTS)technology in pathogenic diagnosis of patients with severe sepsis. Methods A total of 122 patients with severe sepsis were randomly divided into research group 62(cases) and control group(60 cases). Patients in the research group received blood culture(BC) combined HTS test, and patients in the control group received BC test. Both groups of patients received empirical anti-infective treatment. The results and types of pathogen diagnosis was collected, and the positive rate of pathogen diagnosis and virus diagnosis were compared between the two groups. The diagnostic positive rate after empirical anti-infective treatment, hospitalization time in intensive care unit(ICU), 28 d survival rate and occurrence of complications were compared between the two groups. Results There were 58 patients with positive pathogen diagnosis in 62 patients of the research group, and 24 patients with positive pathogen diagnosis in 60 patients of the control group. The positive rate of pathogen diagnosis 93.55%(58/62) of the research group was higher than that of the control group 40.00%(24/60), and positive rate of virus diagnosis 20.97%(13/62) was higher than that of the control group 0(0/60), and the difference was statistically significant(χ~2=39.675, 14.081, P<0.05). After empirical anti-infective treatment, the diagnosis-positive rate of the research group was 32.26%, which was higher than that of the control group 15.00%, and the difference was statistically significant(χ~2=5.012, P<0.05). There was no statistically significant difference in incidence of complications between the two groups(P>0.05). The hospitalization time in ICU(10.04±2.06) d of the research group was shorter than that of the control group(18.25±2.87) d, and 28 d survival rate 85.48% was higher than that of the control group 56.67%, and the difference was statistically significant(P<0.05). Conclusion HTS has a wide range of detection, and can improve the diagnosis-positive rate of pathogenic microorganisms in patients with severe sepsis, and provide direction for the selection of anti-infective programs for severe sepsis to avoid blind use of antibiotics, shorten the hospitalization time in ICU, and improve survival rate.更多还原