下一代测序在CSF或脑部活检中的诊断产量,用于严重脑炎,需要密集护理
Sarah Benghanem1, Philippe Pérot2, Christophe Rodriguez3
1Neuro-intensive Care Unit, Sorbonne University, APHP, Sorbonne Université, La Pitié Salpêtrière Hospital, APHP, Paris, France.
Neurology. Clinical practice
|November 17, 2025
概括
大脑活检上的新一代元基因组测序 (mNGS) 比大脑脊髓液 (CSF) 更有效,用于诊断重症患者的未知病因的脑炎. 这种方法可以减少诊断的不确定性,并指导治疗决策.
科学领域:
- 神经学 神经学
- 传染性疾病 传染性疾病
- 基因组学就是基因组学.
背景情况:
- 未知病因的脑炎在重症患者中构成诊断挑战.
- 甲基因组下一代测序 (mNGS) 为识别致病原体提供了一个潜在的工具.
- mNGS的诊断产量可能因样本类型而异.
研究的目的:
- 评估mNGS在患有未知病因的脑炎的重症患者中的贡献.
- 为了比较对脑脊液 (CSF) 进行的mNGS的诊断产量与脑活检.
- 评估mNGS对治疗开始和患者治疗结果的影响.
主要方法:
- 在第三级护理神经ICU进行的回顾性研究 (2016-2023年).
- 纳入标准:未知病因的脑炎与mNGS在CSF上,大脑活检或尸检.
- 评估mNGS产量,治疗开始和1年神经结果 (GOSE).
主要成果:
- 脑活检上的mNGS与CSF (17.5%阳性,2.5%因果) 相比,具有更高的阳性和因果性收益率 (36.8%).
- 总体而言,14.3%的患者通过mNGS识别了致病原体,主要来自免疫受损个体的大脑活检.
- 在57%的阳性mNGS结果的患者中,开始了特定的治疗.
结论:
- 在脑活检上进行的mNGS对于减少未知病因的脑炎的诊断不确定性是有价值的.
- 脑活检mNGS在这种患者群体中对病原体检测方面优于CSFmNGS.
- 通过mNGS识别致病原体可以告知有针对性的治疗干预措施.
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