目的 探讨宏基因组二代测序（mNGS）在中性粒细胞减少伴发热（FN）白血病患儿中的应用价值。方法 回顾性分析2018年1月1日至2021年7月1日儿科重症监护病房收治的白血病化疗后合并FN患儿的临床资料。根据感染灶分为A组（血流感染组）和B组（肺部感染组）,比较两组mNGS与传统病原检测（TPD）的效能。结果 共纳入56例患儿,男27例、女29例,中位年龄4.0（2.0~7.8）岁。A组39例,ALL28例、AML11例;B组17例,ALL10例、AML7例。A组和B组最常见的病原均为曲霉菌、念珠菌和鲍曼不动杆菌。mNGS与TPD检测阳性率的一致性较差（Kappa=0.039）;mNGS检测阳性率（80.4%）明显高于TPD（58.9%）,差异有统计学意义（P=0.023）。A组mNGS对曲霉菌（35.9%对12.8%）、念珠菌（28.2%对10.3%）和鲍曼不动杆菌（28.2%对7.7%）的检测阳性率均高于TPD;B组mNGS对曲霉菌（41.2%对5.9%）的检测阳性率高于TPD,差异均有统计学意义（P<0.05）。mNGS可检测罕见病原,且对混合感染的检出率显著高于TPD,差异有统计学意义（P<0.05）。结论 对于初始抗感染治疗失败的白血病合并FN患儿,最常见致病原为曲霉菌、念珠菌、鲍曼不动杆菌。作为TPD的互补手段,mNGS对常见病原检测阳性率更高,对混合感染和罕见病原检测效能突出。

Objective To investigate the application value of metagenomic next-generation sequencing (mNGS) in leukemia children with febrile neutropenic (FN). Methods The clinical data of leukemia children combined with FN after chemotherapy admitted to the pediatric intensive care unit from January 1, 2018 to July 1, 2021 was retrospectively analyzed. The children were divided into group A (bloodstream infection group) and group B (pulmonary infection group) according to the infection foci, and the efficacy of mNGS and traditional pathogen detection (TPD) in the two groups was compared. Results A total of 56 children (27 boys and 29 girls) were included, with a median age of 4.0 (2.0-7.8) years. There were 39 cases in group A (28 cases of ALL and 11 cases of AML) and 17 cases in group B (10 cases of ALL and 7 cases of AML). The commonest pathogens in group A and B were Aspergillus, Candida and Acinetobacter baumannii. The consistency of positive rate of mNGS and TPD was poor (Kappa=0.039). The mNGS positive rate (80.4%) was significantly higher than TPD (58.9%), and the difference was statistically significant (P=0.023). In group A, the positive rates of mNGS for Aspergillus (35.9% vs. 12.8%), Candida (28.2% vs. 10.3%) and Acinetobacter baumannii (28.2% vs. 7.7%) were higher than those of TPD; in group B, the positive rate of mNGS for Aspergillus (41.2% vs. 5.9%) was higher than that of TPD, and the differences were statistically significant (P<0.05). The mNGS can detect rare pathogens, and the detection rate of mNGS for mixed infection was significantly higher than that of TPD, and the difference was statistically significant (P<0.05). Conclusions In leukemia children with FN who failed in initial antibiotic therapy, the commonest pathogens were Aspergillus, Candida, and Acinetobacter baumannii. As a complementary tool for TPD, mNGS has a higher positive detection rate for common pathogens and outstanding efficacy for mixed infections and rare pathogens.