摘要
目的比较支气管肺泡灌洗液(BALF)宏基因组二代测序(mNGS)、Xpert、抗酸染色诊断肺结核的效能,探讨BALFmNGS对肺结核的诊断价值。方法2021年5月—2023年7月河南省人民医院诊治疑似肺结核患者265例,均行支气管镜检查及BALFmNGS、Xpert、抗酸染色检测。以病原学和组织病理学结果为肺结核诊断标准,265例患者中肺结核34例为肺结核组,非肺结核231例为非肺结核组,比较2组年龄、肺部合并症等临床资料及mNGS检出的混合感染病原微生物,计算BALFmNGS、Xpert、抗酸染色对结核分枝杆菌复合群的检出率及诊断肺结核的灵敏度和特异度。观察肺结核组BALFmNGS检出低序列数情况,比较Xpert、抗酸染色阳性与阴性者mNGS序列数。结果肺结核组年龄[47.5(30.0,70.5)岁]小于非肺结核组[59.0(50.0,69.0)岁](Z=2.317,P=0.021),肺部合并症、肺外合并症及BALFmNGS检出的混合感染病原微生物与非肺结核组比较差异均无统计学意义(P>0.05)。34例肺结核患者中BALFmNGS阳性29例,Xpert阳性24例,抗酸染色阳性11例,其中mNGS、Xpert、抗酸染色均阳性8例,mNGS、Xpert均阳性22例,mNGS、抗酸染色均阳性8例。BALFmNGS、Xpert对结核分枝杆菌复合群的检出率(10.9%、9.1%)均高于抗酸染色(4.2%)(χ^(2)=8.654,P=0.003;χ^(2)=6.050,P=0.012),BALFmNGS与Xpert比较差异无统计学意义(χ^(2)=0.900,P=0.343)。BALFmNGS、Xpert诊断肺结核的灵敏度(85.3%、70.6%)均高于抗酸染色(32.4%)(χ^(2)=12.042,P<0.001;χ^(2)=8.471,P=0.002),BALF mNGS与Xpert比较差异无统计学意义(χ^(2)=1.778,P=0.180)。BALF mNGS、Xpert、抗酸染色诊断肺结核的特异度(100.0%、99.6%、99.1%)比较差异无统计学意义(χ^(2)=2.000,P=0.368)。BALFmNGS联合Xpert诊断肺结核的灵敏度(91.2%)高于Xpert(χ^(2)=5.143,P=0.016),与BALFmNGS比较差异无统计学意义(χ^(2)=0.500,P=0.500),特异度(99.6%)与BALFmNGS、Xpert比较差异均无统计学意义(χ^(2)<0.001,P>0.999;χ^(2)<0.001,P>0.999)。�
Objective To compare the efficiencies of bronchoalveolar lavage fluid(BALF)metagenomic next-generation sequencing(mNGS),Xpert and acid-fast staining on the diagnosis of pulmonary tuberculosis,and to explore the diagnostic value of BALF mNGS for pulmonary tuberculosis.Methods Totally 265 patients with suspected pulmonary tuberculosis received bronchoscopy,and BALF mNGS,Xpert and acid-fast staining in Henan Provincial People's Hospital from May 2021 to July 2023,and were divided into pulmonary tuberculosis group(n=34)and non-pulmonary tuberculosis group(n=231)according to the etiology and histopathological results.The clinical data as age and pulmonary comorbidities as well as the mixed infectious pathogenic microorganisms detected by mNGS were compared between two groups.The detection rates of Mycobacterium tuberculosis complex by BALF mNGS,Xpert and acid-fast staining,as well as their sensitivities and specificities in the diagnosis of pulmonary tuberculosis were calculated.The low sequence number detected by BALF mNGS was recorded in pulmonary tuberculosis group,and the numbers of mNGS sequences were compared between patients with positive and negative Xpert and acid-fast staining.Results The patients were younger in pulmonary tuberculosis group[47.5(30.0,70.5)years]than in non-pulmonary tuberculosis group[59.0(50.0,69.0)years](Z=2.317,P=0.021),and there were no significant differences in the pulmonary comorbidities,extrapulmonary comorbidities,and mixed infectious pathogenic microorganisms detected by BALF mNGS between two group(P>0.05).In 34 patients with pulmonary tuberculosis,there were 29 cases of BALF mNGS positive,24 of Xpert positive,11 of acid-fast staining positive,8 cases of mNGS+Xpert+acid-fast staining positive,22 of both mNGS and Xpert positive,and 8 of both mNGS and acid-fast staining positive.The detection rate of Mycobacterium tuberculosis complex was higher by BALF mNGS(10.9%)and Xpert(9.1%)than that by acid-fast staining(4.2%)(x^(2)=8.654,P=0.003;x^(2)=6.050,P=0.012),and showed no significant
作者
况红艳
蒋亚芬
赵志刚
刘海洋
张晓菊
KUANG Hongyan;JIANG Yafen;ZHAO Zhigang;LIU Haiyang;ZHANG Xiaoju(Department of Respiratory and Critical Care Medicine,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China)
出处
《中华实用诊断与治疗杂志》
2024年第4期402-406,共5页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省科技攻关计划项目(182102310549)。
关键词
肺结核
宏基因组二代测序
支气管肺泡灌洗液
pulmonary tuberculosis
metagenomic next-generation sequencing
bronchoalveolar lavage fluid
