tNGS在分枝杆菌病诊断中的价值  

The value of tNGS in the diagnosis of mycobacterial disease

作　　者：吴睿彦[1] 陈品儒[1] 邓政先 陈慧玉[1] 许柳清[1] 谭耀驹[1] WU Ruiyan;CHEN Pinru;DENG Zhengxian;CHEN Huiyu;XU Liuqing;TAN Yaoju(Guangzhou Chest Hospital Severe Tuberculosis Medicine Zone,Guangzhou Key Laboratory of Tuberculosis.Guangzhou,Guangdong 510095,China)

机构地区：[1]广州市胸科医院重症结核科内一区/广州市结核病研究重点实验室,广东广州510095

出　　处：《临床肺科杂志》2024年第9期1304-1308,1314,共6页Journal of Clinical Pulmonary Medicine

基　　金：广州市科技市校(院)企联合资助项目(No.2023A03J0991);广州市医学重点学科(2021-2023)结核病学;广州市科技计划项目(No.2023A03J0539)。

摘　　要：目的 探讨tNGS检测技术在诊断分枝杆菌病中的应用价值。方法 对137例疑诊分枝杆菌病的患者行纤支镜检查,支气管肺泡灌洗液BALF样本送检tNGS检测、分枝杆菌培养+菌种鉴定检查,比较两种检测方法的阳性率。结果 通过tNGS检测圣乔治诺卡菌3例。134例分枝杆菌病患者,tNGS对分枝杆菌检测阳性率86.57%,分枝杆菌培养阳性率78.36%,差异没有统计学意义(P>0.05)。对于NTM病检测的tNGS阳性率80.53%,分枝杆菌培养阳性率83.19%;对于活动性结核病,tNGS检测阳性率为100%,分枝杆菌培养阳性率47.6%。tNGS与分枝杆菌培养菌种鉴定应用于分枝杆菌病、NTM病检测报告一致或为同一分枝杆菌复合群仅分别占比58.4%及61.9%,单独应用tNGS对病患做出病原学诊断仍存在假阳性或假阴性可能。结论 tNGS技术逐渐成熟,在临床广泛使用,在鉴定分枝杆菌菌种、鉴别“涂片抗酸染色阳性”的病原体,有较高的参考价值,在确定病原体的诊断时应结合患者病史、临床症状、检查结果等综合分析。Objective To explore the application value of tNGS detection technology in the diagnosis of mycobacterial diseases.Methods BALF sample fibro bronchoscopy was performed on 137 patients suspected of Mycobacteriosis,and bronchoalveolar lavage fluid BALF specimens were collected.Results Three cases of St.George′s Nocardia were detected through tNGS.Among 134 patients with mycobacterial disease,the positive rate of tNGS detection for mycobacteria was 86.57%,while bacillus culture was 78.36%,with no significant difference(P>0.05).The positive rate of tNGS for NTM was 80.53%,and the positive rate of Mycobacterium culture was 83.19%.For active tuberculosis,the positive rate of the tNGS test was 100%,and the positive rate of mycobacterium culture was 47.6%.The application of tNGS and mycobacterial culture identification in the detection of mycobacterial diseases and NTM diseases was consistent or only accounted for 58.4%and 61.9%respectively of the same mycobacterial complex group,and there was still the possibility of false positive or false negative results when tNGS was used alone for pathogen diagnosis of patients.Conclusion The tNGS technology is gradually maturing and finding broad applications in clinical practice.It offers high reference value in identifying mycobacterial strains and identifying pathogens with positive acid-fast staining on the smear.When determining the diagnosis of pathogens,a comprehensive analysis should be conducted,considering the patient′s medical history,clinical symptoms,and test results.

关 键 词：tNGS 分枝杆菌病 非结核分枝杆菌病 结核病 

分 类 号：R516[医药卫生—内科学]