PCR/16sRNA联合核苷酸测序法检测化脓性脑膜炎病原菌的临床价值

目的:探讨PCR/16sRNA联合核苷酸测序法在化脓性脑膜炎病原菌检测中的临床诊断价值。方法:选择2016年4月至2017年2月上海儿童医学中心临床考虑中枢感染的43例化脓性脑膜炎患儿的脑脊液标本,所有患儿标本同时进行培养,并行PCR/16sRNA联合核苷酸测序法检测,记录检测结果,并统计检测方法的灵敏度和特异度,以脑脊液培养检测结果为金标准,对比脑脊液培养和PCR/16sRNA联合核苷酸测序法的灵敏度和特异度。结果:脑脊液培养的灵敏度为21.7%,特异度为100.0%;PCR/16sRNA联合核苷酸测序的灵敏度为69.6%,特异度为95.0%;两者的灵敏度比较差异具统计学意义(P0.05),而两者特异性比较差异无统计学意义(P0.05)。PCR/16sRNA联合核苷酸测序可检出脑脊液培养阴性的病原体。结论:PCR/16sRNA联合核苷酸测序具有较高的灵敏度,可检出脑脊液培养阴性的病原体,且受抗菌药物影响小,可为临床早期提供化脓性脑膜炎的病原学依据,降低致死率及致残率。

Clinical Value of PCR/16sRNA Combined With Nucleotide Sequencing Method in Detecting Purulent Meningitis Pathogens

ABSTRACT Objective: To investigate the clinical value of PCR/16sRNA combined with nucleotide sequencing method in the de- tection of purulent meningitis pathogens. Methods: Cerebrospinal fluid (CSF) specimens of 43 children with purulent meningitis in Shanghai Children''s Medical Center from April 2016 to February 2017 were selected, all specimens were cultured simultaneously, which were detected by PCR/16sRNA sequencing combined with nucleotide sequencing. The detection results were recorded, and the sensitivi- ty and specificity of the detection method were statistically analyzed, and the sensitivity and specificity of CSF culture and PCR/16sRNA combined nucleotide sequencing were compared with CSF culture test results as gold standard. Results: The sensitivity of CSF culture was 21.7%, the specificity was 100.0%, the sensitivity of PCR/16sRNA was 69.6%, the specificity was 95.0%, and the difference of sen- sitivity between the two methods was statistically significant (P<0.05), but there was no significant difference between the two methods (P>0.05). PCR/16sRNA combined with nucleotide sequencing could detect cerebrospinal fluid culture negative pathogens. Conclusion: PCR/16sRNA combined with nucleotide sequencing has higher sensitivity, it can detect cerebrospinal fluid culture negative pathogens, and less affected by antibiotics.It can provide the early clinical pathogen diagnosis of purulent meningitis, reduce mortality and morbidity.