mNGS在诊断痰涂阴性肺结核合并真菌感染中的应用  

Application of mNGS in the diagnosis of smear-negative pulmonary tuberculosis complicated with fungal infection

作　　者：唐彬 黄屹 TANG Bin;HUANG Yi(Department of Respiratory Medicine,Hunan Chest Hospital,Changsha,Hunan 410006,China)

机构地区：[1]湖南省胸科医院呼吸内科,湖南长沙410006

出　　处：《临床肺科杂志》2025年第5期767-770,782,共5页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨对支气管肺泡灌洗液(BALF)进行病原宏基因组高通量测序(mNGS)在痰涂阴性肺结核合并真菌感染患者中的诊断价值。方法选取湖南省胸科医院收治的疑似痰涂阴性肺结核患者200例。最终临床诊断肺结核患者124例,非肺结核患者76例。患者均行BALF常规检测和BALF mNGS检测,分别比较不同检查方法对结核分枝杆菌(MTB)及真菌的诊断效率,分析痰涂阴性肺结核合并真菌感染的危险因素。结果痰涂阴性患者行BALF mNGS检测MTB的灵敏度是58.1%,高于BALF涂片16.1%和BALF培养20.2%,差异有统计学意义(P<0.05);BALF mNGS检测真菌的灵敏度是94.4%,高于BALF培养55.6%,差异有统计学意义(P<0.05);痰涂阴性肺结核患者合并真菌感染率12.9%,非肺结核患者合并真菌感染率2.6%,差异有统计学意义(P<0.05);糖尿病病史、使用抗生素时间>14天与痰涂阴性肺结核合并真菌感染显著相关,差异有统计学意义(P<0.05)。结论疑似痰涂阴性肺结核,伴有糖尿病病史或使用抗生素时间>14天的患者行BALF mNGS检测可以提高诊断效率。Objective To investigate the diagnostic value of pathogen metagenomic high-throughput sequencing(mNGS)of bronchoalveolar lavage fluid(BALF)in sputum negative pulmonary tuberculosis complicated with fungal infection.Methods A total of 200 patients with suspected smear-negative pulmonary tuberculosis were selected from Hunan Chest Hospital.The final clinical diagnosis was 124 patients with tuberculosis and 76 patients without tuberculosis.BALF routine detection and BALF mNGS detection were performed in all patients.The diagnostic efficiency of different detection methods for Mycobacterium tuberculosis(MTB)and fungi was compared,and the risk factors of sputum smear-negative tuberculosis combined with fungal infection were analyzed.Results The sensitivity of BALF mNGS to detect MTB in patients with negative sputum smear was 58.1%,higher than that of BALF smear 16.1%and BALF culture 20.2%,the difference was statistically significant(P<0.05).The sensitivity of BALF mNGS to detect fungi was 94.4%,55.6%higher than BALF culture,the difference was statistically significant(P<0.05).The fungal infection rate was 12.9%in sputum smear negative pulmonary tuberculosis patients and 2.6%in non-pulmonary tuberculosis patients,the difference was statistically significant(P<0.05).The history of diabetes mellitus and the duration of antibiotic use>14 days were significantly correlated with sputum smear-negative tuberculosis complicated with fungal infection,and the difference was statistically significant(P<0.05).Conclusion The BALF mNGS test can improve the diagnostic efficiency in patients with suspected sputum negative tuberculosis,a history of diabetes,or antibiotic use for more than 14 days.

关 键 词：宏基因组 痰涂阴性 肺结核 真菌 肺泡灌洗液 

分 类 号：R521[医药卫生—内科学]