宏基因捕获法二代测序动态检测在合并长程器官功能衰竭的急性胰腺炎中应用价值研究

doi:10.19538/j.cjps.issn1005-2208.2025.10.16

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (10) : 1155-1160. DOI: 10.19538/j.cjps.issn1005-2208.2025.10.16

论著

宏基因捕获法二代测序动态检测在合并长程器官功能衰竭的急性胰腺炎中应用价值研究

孙泽芳1,2，张译之3，余艳4，李嘉荣1,2，郭蓉1,2，刘柏岐1,2，林嘉晏1,2，曹昕彤1,2，陈璐1,2，申鼎成1,2，刘志勇5，周建亮3，黄耿文1,2

作者信息 +

文章历史 +

摘要

目的探讨宏基因捕获法（MetaCAP）二代测序技术连续动态检测在合并长程器官功能衰竭（Pro-OF）的重症急性胰腺炎（SAP）病人中的临床应用价值。方法前瞻性分析2024年1月至2025年9月中南大学湘雅医院胰腺外科和重症医学科、湖南医药学院总医院重症医学科连续收治的65例合并Pro-OF的SAP病人，行外周血MetaCAP连续动态检测（1次/周），分析其诊断效能及预后价值。结果 65例Pro-OF病人共进行101次血 MetaCAP检测，阳性率为51.5%（52/101），较传统血培养阳性率（25.7%）显著增高（P=0.005）。血MetaCAP病原检测结果与各部位微生物培养结果的相符率达90.9%，与胰周积液和呼吸道标本的相符率分别为85.2%和67.9%。器官衰竭时间>2周时，血MetaCAP阳性率由27.5%增高至61.1%，白细胞计数、C-反应蛋白和降钙素原水平未呈现类似变化。26例MetaCAP连续动态检测病人中，检测结果呈持续阳性者的病死率较持续阴性者明显增加（58.8% vs. 11.1%，P=0.036）。结论 SAP病人器官衰竭持续时间越长，血流感染风险越高；血MetaCAP连续动态检测不仅可以精确指导临床抗感染治疗，而且对合并Pro-OF的SAP病人具有重要预后价值。

Abstract

To evaluate the clinical utility of continuous dynamic testing using the Metagenomic Capture (MetaCAP) next-generation sequencing technique in severe acute pancreatitis (SAP) patients complicated by prolonged organ failure (Pro-OF). Methods A prospective analysis was conducted on 65 SAP patients with Pro-OF from Xiangya Hospital of Central South University and Hunan Medical College General Hospital between January 2024 and September 2025. All patients underwent weekly peripheral blood MetaCAP dynamic detection to assess its diagnostic efficacy and prognostic value. Results Among the 65 Pro-OF patients, a total of 101 blood MetaCAP tests were performed, with a positivity rate of 51.5% (52/101), significantly higher than the positivity rate of traditional blood culture (25.7%,P=0.005). The overall concordance rate between MetaCAP pathogen detection results and microbiological culture results from various sampling sites was 90.9%, with concordance rates of 85.2% and 67.9% for peripancreatic and respiratory specimens, respectively. When organ failure duration exceeded two weeks, the MetaCAP positivity rate surged from 27.5% to 61.1%, whereas white blood cell count, C-reactive protein, and procalcitonin levels showed no similar trends. In patients undergoing continuous MetaCAP dynamic monitoring, mortality was significantly higher in those with persistently positive results compared to those with persistently negative results (58.8% vs. 11.1%, P=0.036). Conclusions In patients with SAP, prolonged duration of organ failure is associated with an increased risk of bloodstream infection (BSI), predominantly originating from peripancreatic and respiratory infections. Continuous dynamic monitoring of blood samples using MetaCAP not only provides accurate guidance for clinical anti-infective therapy, but also holds significant prognostic value for SAP patients complicated with Pro-OF.

导出引用

孙泽芳1, 2, 张译之3, 余艳4, 李嘉荣1, 2, 郭蓉1, 2, 刘柏岐1, 2, 林嘉晏1, 2, 曹昕彤1, 2, 陈璐1, 2, 申鼎成1, 2, 刘志勇5, 周建亮3, 黄耿文1, 2. 宏基因捕获法二代测序动态检测在合并长程器官功能衰竭的急性胰腺炎中应用价值研究[J]. 中国实用外科杂志. 2025, 45(10): 1155-1160 https://doi.org/10.19538/j.cjps.issn1005-2208.2025.10.16

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