支气管肺泡灌洗液纳米孔测序对涂片阴性肺结核诊断价值的验证性研究  

Diagnostic value of a nanopore sequencing assay of bronchoalveolar lavage fluid in smear-negative pulmonary tuberculosis

作　　者：闫晓婧 王庆枫[1] 杨扬[1] 初乃惠[1] 聂文娟[1] Yan Xiaojing;Wang Qingfeng;Yang Yang;Chu Naihui;Nie Wenjuan(DepartmentⅠof Tuberculosis,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京胸科医院结核一科,北京101149

出　　处：《中国防痨杂志》2023年第5期487-492,共6页Chinese Journal of Antituberculosis

基　　金：北京滚动课题项目(结核2023-3);高层次公共卫生技术人才建设项目;首都医科大学临床专科开放课题(CCMU2022ZKYXZ003)

摘　　要：目的:验证纳米孔测序技术用于疑似肺结核患者支气管肺泡灌洗液样本的诊断价值。方法:采集2021年11月至2022年4月首都医科大学附属北京胸科医院就诊的50例符合入组标准的涂片阴性疑似肺结核患者的支气管肺泡灌洗液作为研究样本,对其进行BACTEC MGIT 960液体培养(简称“MGIT 960培养”)、GeneXpert MTB/RIF(简称“Xpert”)和纳米孔测序。以临床最终诊断为参照标准,比较3种方法对诊断肺结核的检测效能。结果:50例疑似肺结核患者中,最终确诊肺结核22例(44.0%)、非结核分枝杆菌病10例(20.0%)和细菌性肺炎18例(36.0%)。以最终临床诊断为参照标准,纳米孔测序测定技术、MGIT 960培养和Xpert检测的敏感度分别为72.7%(16/22)、27.3%(6/22)和31.8%(7/22),特异度分别为78.6%(22/28)、75.0%(21/28)和96.4%(27/28),符合率分别为76.0%(38/50)、54.0%(27/50)和68.0%(34/50),约登指数分别为0.51、0.02和0.28。结论:纳米孔测序检测BALF样本具有较Xpert和MGIT 960培养更好的诊断效能,可提升疑似肺结核患者BALF的阳性检出率,但不能完全排除肺结核。Objective:To determine the diagnostic accuracy of a nanopore sequencing assay for testing of bronchoalveolar lavage fluid(BALF)samples from suspected pulmonary tuberculosis(PTB)patients.Methods:Fifty cases with suspected PTB from Beijing Chest Hospital from November 2021 to April 2022 were collected.These cases were diagnosed based on results of MGIT 960 culture,GeneXpert MTB/RIF testing and nanopore sequencing of BALF samples collected during hospitalization.Taking the final clinical diagnosis as the reference standard,diagnostic accuracies of the three assays were compared.Results:Among the 50 cases analysed in this study,22(44.0%)were diagnosed as tuberculosis,10(20.0%)non-tuberculous mycobacteria and 18(36.0%)bacterial pneumonia.Taking the clinic diagnosis as the reference standard,the sensitivity of nanopore sequencing assay technology,MGIT 960 culture and Xpert assay were 72.7%(16/22),27.3%(6/22)and 31.8%(7/22),respectively,the specificity were 78.6%(22/28),75.0%(21/28)and 96.4%(27/28),respectively,the accuracy were 76.0%(38/50),54.0%(27/50)and 68.0%(34/50),respectively,and the Yoden index was 0.51,0.02 and 0.28,respectively.Conclusion:Nanopore sequencing assay of BALF samples may have better diagnostic performance than Xpert and MGIT 960 cultures,and may improve the positive detection rate of BALF in suspected PTB patients.But this method cannot exclude pulmonary tuberculosis.

关 键 词：结核 肺 支气管肺泡灌洗液 纳米技术 分子诊断技术 对比研究 

分 类 号：R521[医药卫生—内科学] R446[医药卫生—临床医学]