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下一代测序优于基于培养的方法,用于在肝移植后检测胆汁中的细菌基因

Björn Grobe^1,2, Freya Wellhöner¹, Friederike Klein^1,2,3

¹Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.

Journal of clinical and experimental hepatology

|December 11, 2023

概括

下一代测序 (NGS) 为肝移植患者提供了比标准微生物培养 (SMC) 更好的胆汁细菌检测. 将NGS与SMC结合起来,可以改善针对胆道并发症的向抗生素治疗的诊断.

科学领域:

肝病学肝病学是一种肝病学.
微生物学微生物学
移植医学移植医学

背景情况:

细菌性胆道炎是肝移植 (LTX) 后经常出现的并发症,特别是在缺血性胆道病变或解剖狭窄的情况下.
目前的诊断依赖于胆汁的标准微生物培养 (SMC),在检测所有相关细菌方面存在局限性.
抗生素治疗的决定是基于SMC的,由于微生物的识别不完整,可能导致次优治疗.

研究的目的:

评估下一代测序 (NGS) 的诊断价值,作为SMC的辅助.
为了比较从肝移植接受者的胆汁样本中NGS与SMC的细菌检测能力.
评估NGS在提高细菌性胆道炎诊断精度方面的潜力.

主要方法:

总共有242个储存的胆汁样本从LTX后的患者使用NGS针对16SrRNA基因进行了分析.
作为常规临床护理的一部分,SMC对135 (56%) 的新鲜胆汁样本进行了检查.
从NGS的结果与SMC的发现进行了比较,以确定细菌属检测的差异.

主要成果:

在胆汁样本中,NGS检测到的细菌属明显多于SMC (P = 5.42 × 10−74).
与NGS相比,SMC显示细菌属的发现不足,缺少通过测序识别的众多属.
NGS显示出更高的灵敏度,即使在内镜逆行胆血管学 (ERC) 之前接受过抗生素的患者中也是如此.

结论:

对于从肝移植患者的胆汁样本中检测细菌,NGS比SMC更敏感.
临床参数没有改善SMC的发现率,突出其局限性.
建议采用使用NGS和SMC的综合方法,以提高诊断能力和更有针对性的抗生素治疗.

关键词:

胆道疾病胆道疾病胆管炎是一种炎.文化技术文化技术文化技术高通量核酸测序的测序肝移植肝移植肝移植

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