肺泡灌洗液宏基因组二代测序对疑似肺结核的诊断价值  

Diagnostic value of metagenomic next-generation sequencing of bronchoalveolar lavage fluid in suspected pulmonary tuberculosis

作　　者：赵素娥 高欣[2] 刘胜岗 龙静 周丽华 ZHAO Su-e;GAO Xin;LIU Sheng-gang;LONG Jing;ZHOU Li-hua(Department of Respiratory Medicine,Changsha Central Hospital Affiliated to University of South China,Changsha,Hunan 410004,China;Department of Tuberculosis Medicine,Changsha Central Hospital Affiliated to University of South China,Changsha,Hunan 410004,China)

机构地区：[1]南华大学附属长沙中心医院.呼吸病诊疗中心,湖南长沙410004 [2]南华大学附属长沙中心医院结核病诊疗中心,湖南长沙410004

出　　处：《临床肺科杂志》2022年第5期722-725,743,共5页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨肺泡灌洗液宏基因组二代测序(mNGS)对肺结核的诊断价值。方法选择2020年5月22日至2021年2月20日长沙市中心医院收治的行痰液及肺泡灌洗液(BALF)结核分枝杆菌(MTB)抗酸染色涂片法、MTB培养法和BALF TB-DNA、Xpert MTB/RIF(简称Xpert)和mNGS检测的疑似肺结核患者,共纳入疑似肺结核155例,其中,肺结核95例,非肺结核60例(感染性疾病54例,嗜血细胞综合征1例,恶性肿瘤5例)。以最终诊断为参考标准,计算BALF mNGS与不同诊断方法诊断效率的差异。结果BALF mNGS诊断肺结核的敏感度为57.89%(55/95),特异度为100%(60/60),阳性预测值为100%(55/55),阴性预测值为60%(60/100)。mNGS诊断肺结核的敏感度明显高于痰涂片法(27.37%,26/95)和痰培养法(30.53%,29/95),也显著高于BALF涂片法(15.79%,15/95)和BALF培养法(20.00%,19/95),差异均有统计学意义(P<0.001);但与BALF Xpert法(58.33%,21/36)和BALF TB-DNA(50%,31/62)相比,差异无统计学意义(P=0.09)。结论BALF mNGS技术可准确、快速测定肺结核患者,较传统方法有较高的灵敏度和特异度,但与BALF Xpert和BALF TB-DNA相比,具有同样的诊断效能。Objective To evaluate the diagnostic value of metagenomic next-generation sequencing(mNGS)of bronchoalveolar lavage fluid(BALF)in pulmonary tuberculosis(PTB).Methods A analysis was performed on suspected pulmonary tuberculosis admitted to Changsha Central Hospital from May 22,2020,to February 20,2021.Mycobacterium tuberculosis(MTB)acid-fast staining smear method and MTB culture method were examined in sputum and BALF.Meanwhile,BALF TB-DNA,Xpert MTB/RIF(Xpert),and mNGS were also tested.A total of 155 suspected pulmonary tuberculosis was finally included,including 95 cases of pulmonary tuberculosis and 60 cases of non-PTB patients(54 cases of infectious diseases,1 case of Hemophagocfitic syndrome,5 cases of malignant tumors).Taking the final diagnosis as the reference standard,the difference in diagnostic efficiency between BALF mNGS and other different diagnostic methods was calculated.Results The sensitivity,specificity,positive predictive value and negative predictive value of BALF mNGS in the diagnosis of pulmonary tuberculosis were 57.89%(55/95),100%(60/60),100%(55/55),and 60%(60/100),respectively.The sensitivity of mNGS in the diagnosis of pulmonary tuberculosis was significantly higher than that of sputum smear(27.37%,26/95)and sputum culture method(30.53%,29/95),and also significantly higher than that of the BALF smear method(15.79%,15/95)and BALF culture method(20.00%,19/95),and the differences were statistically significant(P<0.001).But compared with the BALF Xpert method(58.33%,21/36)and BALF TB-DNA(50%,31/62),the difference was not statistically significant(P=0.09).Conclusion BALFmNGS technology can accurately and rapidly detect PTB patients,and has higher sensitivity and specificity than traditional methods,but has the same diagnostic performance compared with BALF Xpert and BALF TB-DNA.

关 键 词：宏基因组 肺结核 肺泡灌洗液 

分 类 号：R521[医药卫生—内科学]