外周血宏基因组二代测序技术在血液病合并发热患者中的临床应用价值

OBJECTIVE: To investigate the clinical application value of peripheral blood metagenomic next-generation sequencing（mNGS）test for patients with hematological diseases accompanied by fever. METHODS: The blood mNGS results and clinical data of inpatients with hematological diseases accompanied by fever treated in the Hematology Department of Tianjin Medical University General Hospital in March 2020 to June 2021were retrospectively analyzed. A total of 90 patients with 98 cases of specimens were included. The pathogen distribution characteristics and mNGS test performance were analyzed. RESULTS: The positive rate of peripheral blood mNGS was significantly higher than that of traditional examination（68.37％ vs 37.76％, P<0.001）and blood culture（68.37％ vs 9.18％, P<0.001）. Viral, bacterial, and fungal infections accounted for 38.81％, 14.93％, and 2.99％ in patients with single-pathogen infections, respectively. Polymicrobial infections accounted for 43.28％, in which viral and bacterial coinfections were the most common type（25.37％）. There were 55 virus-positive cases（82.09％）, 30 bacteria-positive cases（44.78％）, and 14 fungus-positive cases（20.90％）. The clinical approval rate of peripheral blood mNGS was 64.63％（63/98）. The sensitivity, specificity, positive predictive value, and negative predictive value（NPV）of peripheral blood mNGS were 75.68％, 36.07％, 41.79％, and 70.97％, respectively, and the overall consistency rate with traditional examination was 51.02％. Of the 22 pulmonary infection cases with no detectable pathogens by conventional tests, the pathogens were identified by peripheral blood mNGS in 14 cases, 10 of which were clinically approved. CONCLUSION: The positive rate of peripheral blood mNGS was significantly higher than that of blood culture and traditional laboratory examination. Peripheral blood mNGS had a high clinical recognition rate, sensitivity, and NPV in the detection of pathogens in patients with hematological diseases accompanied by fever.