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目的:探讨宏基因组测序(mNGS)在神经外科重症患者中枢神经系统感染(CNSI)中的应用价值。方法:前瞻性连续纳入自2019年10月至2021年4月收治于河南省人民医院神经外科重症监护室的52例疑似CNSI患者，将采集的脑脊液标本同时行mNGS及传统培养，以CNSI临床诊断标准为依据，对比2种方法的灵敏度、特异度、阳性预测值、阴性预测值以及留取标本送检至结果反馈所用时间。采用受试者工作特征(ROC)曲线分析mNGS与传统培养对CNSI的诊断价值。结果:最终临床诊断CNSI患者25例，其中mNGS阳性23例，包括细菌感染16例、病毒感染4例、真菌感染1例、混合感染2例(细菌+病毒+真菌1例、细菌+病毒1例)；传统培养阳性8例，均为细菌感染。mNGS的灵敏度、特异度、阳性预测值和阴性预测值分别为92.0%、85.2%、85.2%和92.0%，传统培养的灵敏度、特异度、阳性预测值和阴性预测值分别为32.0%、100.0%、100.0%和61.4%。mNGS的结果反馈时间为(31.77±5.23) h，传统培养的结果反馈时间为(101.83±9.15) h，差异有统计学意义(n P<0.05)。ROC曲线显示mNGS诊断CNSI的曲线下面积(AUC)为0.886(n 95%CI：0.786~0.986，n P<0.001)，传统培养诊断CNSI的AUC为0.660(n 95%CI：0.508~0.812，n P=0.002)。n 结论:对于神经外科重症CNSI患者，mNGS具有良好的诊断效能和应用价值，可有效弥补传统脑脊液培养的不足。“,”Objective:To investigate the value of metagenomic next-generation sequencing (mNGS) in central nervous system infection (CNSI) of critically ill patients from Neurosurgery.Methods:A prospective study was conducted. From October 2019 to April 2021, 52 patients with highly suspected CNSI in the Department of Neurosurgical Intensive Care Unit (NICU) of our hospital were chosen. The collected cerebrospinal fluid (CSF) samples were simultaneously performed mNGS and traditional culture; the clinical diagnosis of CNSI was taken as the standard, and the sensitivity, specificity, positive predictive value, negative predictive value, and time from sample collection to result feedback of these two methods were compared. Receiver operating characteristic (ROC) curve was used to analyze the diagnostic values of mNGS and traditional culture in CNSI.Results:Eventually, 25 patients with CNSI were clinically confirmed; 23 were with positive mNGS, including 16 with bacterial infection, 4 with viral infection, 1 with fungal infection, and 2 with mixed infection (1 with bacteria+virus+fungus, 1 with bacteria+virus); 8 were with positive traditional culture, all of which were bacterial infections. The sensitivity, specificity, positive predictive value, and negative predictive value of mNGS were 92.0%, 85.2%, 85.2%, and 92.0%, respectively; those of traditional culture were 32.0%, 100.0%, 100.0%, and 61.4%, respectively; the time from sample collection to result feedback of mNGS and traditional culture was (31.77±5.23) h and (101.83±9.15) h, respectively, with significant difference (n P<0.05). ROC curve showed that the area under the curve (AUC) of mNGS for diagnosis of CNSI was 0.886 (n 95%CI: 0.786-0.986, n P<0.001); the AUC of traditional culture for diagnosis of CNSI was 0.660 (n 95%CI: 0.508-0.812, n P=0.002).n Conclusion:For patients with CNSI from NICU, mNGS has good diagnostic efficacy and application value and can effectively compensate for the lack of traditional cerebrospinal fluid culture.