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对mNGS,PCR和其他用于精确结核病诊断的常规方法的层次整合

Yating Zhao¹, Longting Du¹, Junli Song²

¹Department of Laboratory Medicine, The First Afﬁliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.

Microbiology spectrum

|September 11, 2025

概括

甲基因组下一代测序 (mNGS) 显示出对结核病 (TB) 的诊断具有很高的灵敏度,其性能优于其他方法. 这项研究建议根据医疗保健资源的可用性量身定制结核病检测策略,改善全球结核病检测工作.

科学领域:

临床诊断临床诊断临床诊断
微生物学微生物学
公共卫生公共卫生

背景情况:

结核病 (TB) 仍然是一个全球性卫生挑战,需要准确和可访问的诊断工具.
目前的诊断方法在灵敏度,特异性,成本和操作可行性方面各不相同.
优化结核病诊断对于有效的治疗和控制至关重要,与世卫组织的结核病终结战略保持一致.

研究的目的:

系统地比较七种结核病检测试验的诊断准确性:mNGS,ddPCR,RT-qPCR,EasyNAT,GeneXpert MTB/RIF,IGRA和AFS.
评估这些方法的成本效益和运营可行性.
为拥有多样化的医疗保健资源的地区提出优化结核病检测组合.

主要方法:

对141个疑似活跃结核病患者的样本进行了回顾性分析.
使用mNGS,ddPCR,RT-qPCR和EasyNAT进行并行测试;Xpert,IGRA和AFS的历史数据.
对最终的临床诊断进行诊断性能 (灵敏度,特异性,PPV,NPV) 的评估.
接收器操作特征 (ROC) 曲线分析和DeLong测试用于统计比较.

主要成果:

下一代元基因组测序 (mNGS) 显示出最高的灵敏度 (100%),而Xpert和AFS显示出100%的特异性.
与ddPCR (P=0.031) 相比,ROC分析表明mNGS的曲线下面面积显著更大 (P=0.031).
在mNGS和ddPCR (P<0.05),以及IGRA和AFS (P<0.01) 之间观察到诊断性能的统计学上显著差异.
mNGS独特地识别了共感染病原体和定量读数,有助于复杂的病例.

结论:

mNGS为结核病检测提供了卓越的灵敏度,在复杂病例和共感染中尤其有价值.
推的分层测试策略:AFS + EasyNAT + 胸部X射线用于资源有限的环境;IGRA + RT-qPCR用于初级保健;Xpert MTB/RIF用于中间医院;mNGS和ddPCR用于三级中心.
这些发现为全球优化结核病诊断算法提供了一个框架,提高了可访问性和有效性.

关键词:

简单的EasyNAT可以使用.在MTBC中,我们可以使用MTBC.RT-qPCRR 是一个人.ddPCRR 在线播放 mNGSS 在线观看

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