宏基因组二代测序技术在淋巴结结核诊断中的应用价值  

作　　者：林婷 俞跃辉 罗佳磊 颜心怡 黄向韵 张莹[4] 杨高怡 

机构地区：[1]浙江中医药大学第四临床医学院,310053 [2]杭州师范大学,311121 [3]浙江省医疗诊断数字技术重点实验室,310000 [4]杭州市红十字会医院,310005 [5]西湖大学医学院附属杭州市第一人民医院,310006

出　　处：《浙江临床医学》2025年第3期427-428,共2页Zhejiang Clinical Medical Journal

基　　金：浙江省自然科学基金项目(LTGY23H180005);杭州市生物医药和健康产业发展扶持科技专项(2022WJC046);杭州市卫健委重大项目(Z20230098)。

摘　　要：目的探讨宏基因组二代测序(mNGS)在淋巴结结核诊断中的应用价值。方法选取2022年10月至2023年7月颈部淋巴结肿大并疑似淋巴结结核患者80例,在超声引导下对肿大淋巴结进行穿刺,对组织分别进行培养、Xpert检测,mNGS,以病理诊断为金标准,比较三种检测方法的敏感度、特异度、阴性预测值、阳性预测值。结果根据临床诊断标准明确感染为淋巴结结核61例,非淋巴结结核15例,诊断不明4例。以临床诊断结果为标准,mNGS、常规培养和Xpert检测诊断淋巴结结核的敏感度分别为86.9%、39.3%、62.2%,阴性预测值分别为65.2%、28.8%、39.4%,阳性预测值及特异性均为100%。mNGS敏感度高于Xpert检测和培养(P<0.05)。结论相比于传统病原体检测方式,mNGS诊断淋巴结结核敏感度更高,能检测到其他潜在病原微生物。mNGS对淋巴结结核疑似病例快速诊断具有潜在有效性。Objective To evaluate the diagnostic performance of metagenomic next-generation sequencing(mNGS)in lymph node tuberculosis.Methods A total of 80 patients with enlarged cervical lymph nodes and suspected lymph node tuberculosis from October 2022 to July 2023 were enrolled.Their clinical information was collected.Under the guidance of ultrasound,punctures were carried out on the enlarged lymph nodes.The tissue specimens were then cultured,subjected to Xpert testing,and underwent metagenomic next-generation sequencing respectively.Taking the clinical diagnosis as the gold standard,the sensitivities,specificities,negative predictive values,and positive predictive values of each method were compared.Results Among the 80 patients,based on the clinical diagnostic criteria,61 cases were clearly identified as having lymph node tuberculosis,15 cases as not having lymph node tuberculosis,and 4 cases with an unclear diagnosis.Taking the clinical diagnosis results as the standard,the sensitivities of mNGS,conventional culture,and Xpert testing for lymph node tuberculosis were 86.9%,39.3%,and 62.2%respectively.The negative predictive values were 65.2%,28.8%,and 39.4%respectively,and both the positive predictive values and specificities were 100%.The sensitivity of mNGS was higher than that of Xpert testing and culture(P<0.05).Conclusion Compared with traditional pathogen detection approaches,mNGS exhibits higher sensitivity in diagnosing lymph node tuberculosis and can identify other potential pathogenic microorganisms.mNGS holds potential efficacy for the rapid diagnosis of suspected lymph node tuberculosis cases.

关 键 词：淋巴结 结核 宏基因组二代测序 

分 类 号：R52[医药卫生—内科学]