摘要
目的评估核酸基质辅助激光解吸电离飞行时间质谱(matrix-assisted laser desorption ionization-time of flight mass spectrometry,MALDI-TOF MS)技术在痰抗酸染色涂片阴性非结核分枝杆菌(nontuberculous Mycobacteria,NTM)肺病患者中的诊断价值。方法回顾性收集2022年7月至2023年11月在山东大学附属公共卫生临床中心住院的痰抗酸染色涂片阴性疑似NTM肺病123例患者临床资料。对支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)标本进行MALDI-TOF MS技术检测和MGIT 960培养。评估MALDI-TOF MS技术在痰抗酸染色涂片阴性NTM肺病中的诊断效能。采用SPSS 26.0软件对数据进行统计分析。采用MedCalc统计软件绘制受试者工作特征(receiver operating characteristic,ROC)曲线,并计算曲线下面积(area under curve,AUC)。结果123例痰抗酸染色涂片阴性疑似NTM肺病患者中,最终确诊NTM肺病66例。MALDI-TOF MS检测NTM菌种和耐药的时间为8~24 h,共分离72株NTM,居首位的是鸟分枝杆菌复合群34株(47.22%),其次是脓肿分枝杆菌复合群13株(18.06%),有6例患者检测到大环内酯类耐药,未检测到氨基糖苷类药物耐药。BALF MGIT 960培养和鉴定时间为9~45 d,NTM分型和药敏检测时间为7~15 d,共分离28株NTM,有1例患者检测到大环内酯类耐药。以确诊诊断为金标准,MALDI-TOF MS技术检测痰抗酸染色涂片阴性NTM肺病的敏感度、阴性预测值和符合率均高于MGIT 960培养,差异均有统计学意义(84.85%比42.42%,81.13%比56.32%,80.49%比62.60%,χ^(2)=25.667、8.998和9.664,P<0.05或<0.01)。MALDI-TOF MS技术的ROC AUC为0.801,高于MGIT 960培养的AUC(0.642)。MALDI-TOF MS技术的诊断效能高于MGIT 960培养(Z=3.300,P=0.001)。结论相比MGIT 960培养,MALDI-TOF MS技术在诊断痰抗酸染色涂片阴性NTM肺病患者的诊断效能更高,同时能鉴定NTM菌种及耐药情况,且时间更短。
Objective To investigate the diagnostic value of nucleic acid matrix-assisted laser desorption ionization-time of flight mass spectrometry(MALDI-TOF MS)in sputum smear-negative patients with nontuberculous Mycobacterial(NTM)pulmonary disease.Methods Clinical data of 123 patients suspected of NTM pulmonary disease admitted in Public Health Clinical Center Affiliated to Shandong University between July 2022 and November 2023 were retrospectively analyzed.Bronchoalveolar lavage fluid(BALF)specimens were collected for MALDI-TOF MS assay and MGIT 960 culture.The diagnostic efficacy of MALDI-TOF MS for NTM pulmonary disease in patients with negative sputum smears for acid-fast bacilli was evaluated with receiver operating characteristic(ROC)curve.Statistical analysis was performed using SPSS 26.0 software and MedCalc statistical software.Results Diagnosis of NTM pulmonary disease was finally confirmed in 66 out of the 123 suspected patients.It took 8 to 24 h for MALDI-TOF MS to identify NTM species and resistance.By MALDI-TOF MS,72 NTM strains were identified,with the Mycobacterium avium complex being the most prevalent(34 strains,47.22%),followed by the Mycobacterium abscessus complex(13 strains,18.06%);resistance to macrolides was detected in 6 cases,while no resistance to aminoglycosides was found.It took 9 to 45 days for BALF MGIT 960 culture to identify NTM,and took 7 to 15 days for NTM typing and drug sensitivity testing.By BALF MGIT 960 culture,28 NTM strains were identified;and 1 case was found to be resistant to macrolides.Using confirmed diagnosis as the gold standard,MALDI-TOF MS demonstrated higher sensitivity,negative predictive value,and agreement rate compared to MGIT 960 culture(84.85%vs.42.42%,81.13%vs.56.32%,80.49%vs.62.60%,χ^(2)=25.667,8.998,9.664,P<0.05 or<0.01).The area under ROC curve(AUC)for MALDI-TOF MS was significantly higher than that of MGIT 960 culture(0.801 vs.0.642,Z=3.300,P=0.001).Conclusion Compared to MGIT 960 culture,MALDI-TOF MS exhibits superior diagnostic efficiency in detecting N
作者
高绪胜
丁彩红
王庆
解丹
门凤民
蒋培培
李强
周玲娟
熊瑜
Gao Xusheng;Ding Caihong;Wang Qing;Xie Dan;Men Fengmin;Jiang Peipei;Li Qiang;Zhou Lingjuan;Xiong Yu(Department of Tuberculosis,Public Health Clinical Center Affiliated to Shandong University,Jinan 250102,China;Department of Infectious Diseases,Leling People's Hospital,Dezhou 253699,Shandong Province,China;Department of Cardiology,Jinan Fifih People's Hospital,Jinan 250022,China)
出处
《中华临床感染病杂志》
CAS
CSCD
北大核心
2024年第1期58-63,共6页
Chinese Journal of Clinical Infectious Diseases
基金
山东省重点研发计划(重大科技创新工程)项目(2021SFGC0504)
山东省中医药科技项目(2020M059、Z-2022064)
山东省医药卫生科技发展计划项目(202203081026)。
