【摘要】 目的 探讨宏基因组二代测序（mNGS）在中枢神经系统（CNS）感染性疾病诊断中的应用价值。方法 回顾性分析2022年1月～2024年1月期间江门市中心医院神经内科三区收治的62例入院拟诊CNS感染的病例相关资料，根据诊断结果分为CNS感染组、非CNS感染组，其中CNS感染者分为：病毒性组、细菌性组、结核性组、真菌性组。整理研究对象一般临床资料、临床表现，脑脊液m NGS结果及脑脊液常规、生化、培养、墨汁染色等结果，对照分析不同组别临床特征、mNGS结果、脑脊液常规、生化、墨汁染色、影像学检查和其他相关因素的差异性。结果 入组62例患者，其中CNS感染48例（四组：病毒性组25例、细菌性组12例、结核性组8例、真菌性组3例）、非CNS感染14例。mNGS阳性25例，24例与最终诊断符合；传统方法阳性5例都符合最终诊断，两者比较差异有统计学意义（P <0.05）。62例患者传统脑脊液检测结果分析表明：压力方面，只有病毒性组和细菌性组差异有统计学意义（P <0.05）；白细胞数方面，细菌性组与其他四组差异有统计学意义（P <0.05）；蛋白数方面，病毒性组和细菌性组差异有统计学意义（P <0.05）；葡萄糖方面，病毒性组分别与其他三组CNS感染差异有统计学意义（P <0.05）；氯化物方面，病毒性组分别与结核性、真菌性组差异有统计学意义（P <0.05）。病毒性组mNGS灵敏度52.00%；细菌性组mNGS灵敏度41.67%；结核性组mNGS灵敏度50.00%；真菌性组，mNGS灵敏度66.67%。同一种CNS感染类型中，脑脊液白细胞数越高，mNGS阳性率越高（P <0.05）。结论 与传统方法相比，mNGS对CNS感染性的诊断准确率更高，对临床诊断有重要价值。更多还原

【Abstract】 Objective To explore the application value of metagenomic next-generation sequencing(mNGS) in the diagnosis of infectious diseases of the central nervous system(CNS). Methods A retrospective analysis was conducted on the clinical data of 62 cases admitted to Department of Neurology Ⅲ at Jiangmen Central Hospital from January 2022 to January 2024 with suspected central nervous system(CNS) infections. Based on the diagnostic results, the cases were divided into a CNS infection group and a non-CNS infection group. The CNS infection group was further categorized into viral, bacterial, tuberculous, and fungal subgroups. General clinical data, clinical manifestations, cerebrospinal fluid(CSF) metagenomic next-generation sequencing(mNGS) results, and traditional CSF tests(including routine examinations, biochemical tests, cultures, and india ink staining) were collected. Comparative analyses were performed to evaluate the differences in clinical features, mNGS results, CSF routine and biochemical parameters, india ink staining, imaging findings, and other relevant factors among the different groups. Results A total of 62 patients were enrolled, including 48 patients with CNS infection(four groups: 25 cases of virus, 12 cases of bacterial, 8 cases of tuberculous, 3 cases of fungal)and 14 patients with non-CNS infection. There were 25 positive cases of mNGS, and 24 of them were consistent with the final diagnosis. 5 cases were positive by traditional methods and all met the final diagnosis. The difference between them was statistically significant(P < 0.05). Analysis of cerebrospinal fluid pressure, routine and biochemical results among 62patients showed that only the pressure of viral and bacterial had statistical difference(P < 0.05). There were statistically significant differences in the number of white blood cell count between bacterial group and other four groups(P < 0.05). There was statistical difference in the number of protein between viral group and bacterial group chlorides. There were statistical differences between the cerebrospinal fluid glucose of viral group and other three CNS infections groups(P < 0.05). The chlorides in viral group were statistically different from those in tuberculous and mycotic groups(P < 0.05). The sensitivity, The sensitivity of mNGS was 52% in the viral group, 41.67% in the bacterial group, 50.00% in the tuberculous group, and 66.67% in the fungal group. Within the same type of CNS infection, a higher CSF white blood cell count was associated with a higher mNGS positivity rate(P < 0.05). Conclusion Compared with traditional methods, mNGS demonstrates higher diagnostic accuracy for CNS infections, offering significant clinical value.更多还原