摘要：

目的: 探讨脑脊液宏基因组学第二代测序在感染后脑积水脑室-腹腔分流术时机选择中的应用价值。方法: 回顾分析2021年1月至2025年12月天津医科大学附属环湖医院15例感染后脑积水患者的临床资料，术前根据脑脊液宏基因组学第二代测序结果明确手术时机，分别于术前、出院时及术后3个月评估神经功能预后[改良Rankin量表（mRS）]、意识状态[Glasgow昏迷量表（GCS）]和手术安全性。结果: 脑脊液宏基因组学第二代测序病原体阳性检出率为15/15，常规脑脊液培养阳性检出率为11/15，但差异无统计学意义（χ² = 2.250，P = 0.125）；脑脊液宏基因组学第二代测序与常规脑脊液培养感染类型分布差异具有统计学意义（χ² = 6.250，P = 0.018）。分流手术前所有患者脑脊液白细胞计数（Z = 3.242，P = 0.001）、蛋白定量（t = 2.750，P = 0.015）和乳酸（Z = 3.417，P = 0.000）均高于正常参考值，但宏基因组学第二代测序结果呈阴性，提示脑脊液已达无菌状态；感染临床治愈至分流手术中位时间为12（6，20）d，术后无再感染病例。术前、出院时及术后3个月mRS（χ² = 27.111，P = 0.000）和GCS（χ² = 19.143，P = 0.000）评分差异具有统计学意义，mRS评分低于术前（Z = 4.930，P = 0.000）和出院时（Z = 2.739，P = 0.019），GCS评分高于术前（Z =-3.925，P = 0.000）。结论: 依据脑脊液宏基因组学第二代测序阴性结果选择实施脑室-腹腔分流术时机安全可行，可有效缩短术前等待时间、降低感染复发风险、改善患者预后，为感染后脑积水分流时机决策提供新的参考依据。

关键词: 中枢神经系统感染, 脑积水, 序列分析，DNA, 序列分析，RNA, 脑室腹膜分流术, 脑脊髓液, 细菌, 培养基

Abstract:

Objective: To investigate the application value of cerebrospinal fluid (CSF)metagenomic next-generation sequencing (mNGS) in determining the timing of ventriculo-peritoneal shunt (VPS) in patients with post-infectious hydrocephalus (PIH). Methods: A retrospective analysis was conducted on clinical data from 15 patients with PIH admitted to Huanhu Hospital Affiliated to Tianjin Medical University from January 2021 to December 2025. All patients underwent CSF mNGS and routine CSF analysis after clinical control of infection and before planned VPS. The time intervals from infection control to shunt surgery and the rate of postoperative reinfection were recorded. Neurological outcome was assessed using the modified Rankin Scale (mRS) and consciousness status using the Glasgow Coma Scale (GCS) before surgery, at discharge, and 3 months after discharge. Results: The pathogen detection rate of mNGS was 15/15, compared to 11/15 for conventional CSF culture, with no statistically significant difference between the two methods (χ² = 2.250, P = 0.125). There was statistically significant difference in distribution of infection types between CSF mNGS and conventional CSF culture (χ² = 6.250, P = 0.018). Although CSF white blood cell count (Z = 3.242, P = 0.001), protein (t = 2.750, P = 0.015), and lactate (Z = 3.417, P = 0.000) levels were significantly above normal ranges before VPS, all CSF mNGS results were negative, indicating a sterile CSF state. The median time from clinical cure of infection to shunt surgery was 12 (6, 20) d, and the postoperative reinfection rate was 0. Statistically significant differences were observed in mRS (χ² = 27.111, P = 0.000) and GCS (χ² = 19.143, P = 0.000) scores before surgery, at discharge, and 3 months after discharge. Pairwise comparison revealed that mRS score 3 months after discharge was lower than that before surgery (Z = 4.930, P = 0.000) and at discharge (Z = 3.739, P = 0.019); and 3 months after discharge GCS score was higher than that before surgery (Z =-3.925, P = 0.000). Conclusions: Early VPS guided by negative CSF mNGS results appears safe and feasible, effectively shortening preoperative waiting time, reducing the risk of infection recurrence, and improving outcomes of PIH patients. This method provides a novel reference for determining the optimal timing of shunt surgery in PIH patients.

Key words: Central nervous system infections, Hydrocephalus, Sequence analysis, DNA, Sequence analysis, RNA, Ventriculoperitoneal shunt, Cerebrospinal fluid, Bacteria, Culture media

中图分类号: 

• R741