宏基因组二代测序对肺结核的诊断价值  

Diagnostic value of metagenomic next-generation sequencing in pulmonary tuberculosis

作　　者：王春 王彩英 刘丹 Wang Chun;Wang Caiying;Liu Dan(Department of Respiratory Medicine,Nanjing Brain Hospital Affiliated to Nanjing Medical University(Nanjing Chest Hospital),Nanjing 210000,China)

机构地区：[1]南京医科大学附属脑科医院呼吸科,南京210000

出　　处：《中华生物医学工程杂志》2021年第5期489-493,共5页Chinese Journal of Biomedical Engineering

摘　　要：目的评估宏基因组二代测序技术(mNGS)在肺结核诊断中的应用价值,并为相应临床标本的选择提供参考。方法通过回顾性研究的方法,查阅电子病历系统中2019年2月至2021年5月期间因疑似肺结核就诊于南京市胸科医院,并行mNGS检测、涂片抗酸染色及结核分枝杆菌(MTB)培养的患者。以临床诊断结果为参考标准,分别计算三种方法诊断肺结核的敏感性及特异性等,并计算mNGS在痰液、肺泡灌洗液、肺组织标本中检测MTB的敏感性及约登指数。结果共入组127例患者,最终临床确诊肺结核103例,mNGS诊断肺结核的敏感性为55.34%(57/103),明显高于涂片抗酸染色(18.45%,19/103)及培养(27.18%,28/103),三者差异有统计学意义(P<0.05)。mNGS诊断肺结核的特异性为95.83%(23/24),余两种方法特异性均为100%,差异无统计学意义(P=0.36)。应用mNGS检测MTB时,肺组织、肺泡灌洗液及痰液的敏感性分别为77.78%(28/36)、58.54%(24/41)、15.79%(3/19),约登指数分别为0.78、0.59及0.16,三者间差异有统计学意义(P<0.05),肺组织优于肺泡灌洗液,痰液价值较低。结论mNGS能显著提高肺结核患者的病原学诊断率,其中肺组织标本的mNGS诊断价值尤高。Objective To evaluate the value of metagenomic next-generation sequencing(mNGS)in diagnosing pulmonary tuberculosis(PTB).Method Included in this retrospective study by retrieval of our medical chart system were patients who were suspected to have PTB and underwent mNGS,acid fast smear,and Mycobacterium tuberculosis(MTB)culture in Nanjing Chest Hospital between February 2019 and May 2021.With clinical diagnosis as the reference standard,the sensitivity,specificity and misdiagnosis rate of the three methods in diagnosing PTB were calculated.The sensitivity and Youden index of mNGS in identifying MTB in sputum,bronchoalveolar lavage fluid(BLF)and lung tissue samples were aslo calculated.Results A total of 127 patients were enrolled.There were 103 patients with confirmed PTB.The sensitivity of mNGS in diagnosing PTB was 55.34%(57/103),which was significantly higher than that of smear(18.45%,19/103)and culture(27.18%,28/103),with statistically significant difference(P<0.05).The specificity of mNGS,smear and culture in diagnosing PTB was 95.83%(23/24),100%(19/19)and 100%(28/28),respectively,with no statistical difference among the three(P=0.36).The sensitivity of mNGS in identifying MTB in sputum,BLF and lung tissue samples was 15.79%(3/19),58.54%(24/41)and 77.78%(28/36),respectively;the Youden indices was 0.16,0.59 and 0.78,respectively,with significant difference(P<0.05).The diagnostic performance of mNGS was high with lung tissue sample,followed by BLF and low with sputum sample.Conclusion mNGS can significantly improve the etiological diagnosis rate of PTB,especially when used for lung tissue samples.

关 键 词：肺结核 诊断 敏感性 宏基因组 

分 类 号：R521[医药卫生—内科学]