mNGS在结核性胸膜炎诊断和耐药性评估中应用价值

Application value of metagenomic second-generation sequencing technology in diagnosis of tuberculous pleurisy and detection of drug resistance to rifampicin therapy

目的:探讨宏基因组二代测序(mNGS)技术在结核性胸膜炎诊断及利福平治疗耐药性评估中的应用价值。方法:选取2019年7月~2020年7月湖南省胸科医院收治的疑似结核性胸膜炎患者100例为研究对象,收集其胸腔积液标本分别行结核分枝杆菌BACTEC MGIT960液体快速培养、胸水腺苷脱氨酶(ADA)、福平耐药实时荧光定量核酸扩增技术(Xpert)以及mNGS检测,比较不同检测方法诊断效能,并对确诊结核性胸膜炎患者胸腔积液标本行比例法药敏实验(DST)、Xpert和mNGS检测,评估利福平耐药性诊断效能。结果:100例研究对象中,80例确诊结核性胸膜炎患者中,利福平治疗耐药7例,耐药率为8.8%。mNGS检测诊断结核性胸膜炎灵敏度、一致性较ADA检测和Xpert检测高。ADA联合mNGS检测诊断结核性胸膜炎灵敏度、一致性较ADA联合Xpert检测高。胸腔积液获取方式对mNGS诊断肺结核灵敏度和特异度均无影响。Xpert检测和mNGS检测评估结核性胸膜炎利福平治疗耐药性灵敏度、特异度差异无统计学意义,但mNGS检测评估利福平治疗耐药性灵敏度较Xpert检测稍低。结论:mNGS技术能够提高早期诊断结核性胸膜炎的正确性,但在利福平耐药性评估中灵敏度较低,建议联合其他检测技术促进其在临床中更好的应用。

Objective To explore the application value of metagenomic second-generation sequencing(mNGS)in the diagnosis of tuberculous pleurisy and the detection of drug resistance to rifampicin.Methods A total of 100 patients with suspected tuberculous pleurisy admitted to our hospital from July 2019 to July 2020 were enrolled.The diagnostic efficacy of different detection methods was compared,and proportional drug sensitivity test(DST),XPERT and MNGS tests were performed on pleural effusion specimens of patients with confirmed tuberculous pleurisy to evaluate the diagnostic efficacy of rifampicin resistance.Results Among the 100 subjects,80 cases were diagnosed with tuberculous pleurisy,with a positive diagnostic rate of 80.0%.Among the patients with tuberculous pleurisy,7 cases were resistant to rifampicin,with a drug resistance rate of 8.8%.The sensitivity and consistency of mNGS in the diagnosis of tuberculous pleurisy were higher than that of ADA and Xpert.The sensitivity and consistency of ADA combined with mNGS were higher than that of ADA combined with Xpert.There was no statistical significance in the sensitivity and specificity of MNGS in the diagnosis of tuberculous pleurisy between B-ultrasonography and open surgical sampling.In the diagnosis of drug resistance,there was no statistical significance in the sensitivity and specificity of Xpert and mNGS in the diagnosis of rifampicin resistance of Mycobacterium tuberculosis in patients with tuberculous pleurisy,but the sensitivity of MNGS was slightly lower than that of Xpert.Conclusion mNGS technique can improve the accuracy of early diagnosis of tuberculous pleurisy,but its sensitivity in rifampicin resistance assessment is low.It is suggested to combine with other detection techniques to promote its better clinical application.