宏基因组二代测序技术和Gene Xpert MTB/RIF对肺结核的诊断价值
Diagnostic Value of Metagenomic Next-Generation Sequencing and Gene Xpert MTB/RIF in Pulmonary Tuberculosis
DOI: 10.12677/ACM.2023.13122685, PDF,   
作者: 陈淑芳*, 姜淑娟#：山东大学齐鲁医学院，山东 济南；山东第一医科大学附属省立医院，呼吸与危重症医学科，山东 济南；李 晶*：山东省公共卫生临床中心，呼吸与危重症医学科，山东 济南；王骏仁：山东第一医科大学附属省立医院，呼吸与危重症医学科，山东 济南
关键词: 结核分枝杆菌；Gene Xpert MTB/RIF；宏基因组二代测序；诊断；Mycobacterium tuberculosis； Gene Xpert MTB/RIF； Metagenomic Next-Generation Sequencing； Diagnosis
摘要: 目的：对比抗酸涂片、结核分枝杆菌培养、结核分枝杆菌及利福平耐药基因检测(Gene Xpert MTB/RIF)和宏基因组二代测序技术(metagenomic next-generation sequencing, mNGS)对肺结核诊断的临床价值。方法：回顾分析2021年3月至2023年4月在山东省公共卫生临床中心就诊的175名疑似肺结核患者的临床资料，所有纳入病例均进行痰抗酸涂片、肺泡灌洗液抗酸涂片、痰培养、肺泡灌洗液培养、肺泡灌洗液Gene Xpert MTB/RIF和mNGS检查。比较抗酸涂片、结核杆菌培养、Gene Xpert MTB/RIF和mNGS诊断肺结核的阳性率。结果：175名疑似结核患者共确诊结核126例，灌洗液Gene Xpert MTB/RI敏感度为77.8%，灌洗液mNGS检查阳性率为85.7%高于痰培养法(46.0%)、灌洗液培养法(57.1%)，对于涂片阴性的结核患者Gene Xpert MTB/RIF和mNGS检查阳性率高于培养法(P < 0.05)。结论：mNGS及Gene Xpert MTB/RIF在诊断肺结核方面具有重要意义，极大提高了涂片阴性检出率。
Abstract: Objective: To compare the diagnostic efficacy of acid-fast smear of Mycobacterium tuberculosis, Gene Xpert MTB/RIF and metagenomic next-generation sequencing (mNGS) in pulmonary tuberculosis. Methods: The clinical data of 175 patients with suspected pulmonary tuberculosis attending the Public Health Clinical Center of Shandong Province from March 2021 to April 2023 were retrospec-tively analyzed, and all the included cases underwent sputum antacid smear, alveolar lavage fluid antacid smear, sputum culture, alveolar lavage fluid culture, alveolar lavage fluid Gene Xpert MTB/RIF, and mNGS. Positive rates of antacid smear, Mycobacterium tuberculosis culture, Gene Xpert MTB/RIF and mNGS for the diagnosis of tuberculosis were compared. Results: A total of 126 cases of TB were diagnosed in 175 patients with suspected TB. The sensitivity of Gene Xpert MTB/RIF in lavage fluid was 77.8%, and the positivity rate of mNGS in lavage fluid was 85.7%, which was higher than that of sputum culture method (46.0%) and lavage culture method (57.1%), and the positivity rate of Gene Xpert MTB/RIF and mNGS was higher than that of culture method (P < 0.05) in smear-negative patients with TB. For smear-negative TB patients, Gene Xpert MTB/RIF and mNGS were more positive than culture method (P < 0.05) Conclusion: mNGS and Gene Xpert MTB/RIF are important in the diagnosis of TB, and greatly increase the detection rate of smear-negative TB.
文章引用：陈淑芳, 李晶, 王骏仁, 姜淑娟. 宏基因组二代测序技术和Gene Xpert MTB/RIF对肺结核的诊断价值[J]. 临床医学进展, 2023, 13(12): 19093-19100. https://doi.org/10.12677/ACM.2023.13122685

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