针对药物耐药结核病诊断的下一代定向测序:对细菌负载,治疗方案选择和诊断算法放置的实施考虑
Sophia B Georghiou1,2, Nestani Tukvadze3,4,5, Camilla Rodrigues6
1FIND, Geneva, Switzerland sgeorghiou@gmail.com.
BMJ global health
|November 5, 2025
概括
目标下一代测序 (tNGS) 提供了快速和全面的耐药结核病 (DR-TB) 检测. 将tNGS集成到诊断工作流中,可以通过补充现有的分子测试来优化治疗决策,以获得更好的患者结果.
科学领域:
- 微生物学 微生物学
- 基因组学就是基因组学.
- 传染性疾病 传染性疾病
背景情况:
- 耐药结核病 (DR-TB) 的早期和准确诊断对于有效治疗至关重要.
- 现型药物敏感性测试 (pDST) 准确但缓慢;快速分子测试的药物覆盖范围有限.
- 针对性下一代测序 (tNGS) 为广泛和快速的抗性检测提供了一个潜在的解决方案.
研究的目的:
- 评估两个tNGS解决方案 (Deeplex Myc-TB和ONT) 在检测DR-TB药物耐药性的性能.
- 将tNGS的性能与世卫组织推的分子测试和pDST进行比较.
- 确定影响tNGS在诊断工作流程中的整合因素.
主要方法:
- 该研究分析了Seq&Treat研究中的三种高负荷DR-TB设置中的763个样本的数据.
- 测序成功率和药物耐药性检测的评估是基于初始的Xpert MTB/RIF结果和世卫组织推的药物治疗方案.
- 性能与世卫组织认可的其他测试进行了比较,考虑了潜在的算法影响.
主要成果:
- 测序成功率很高:GenoScreen的成功率为88.5%,ONT的成功率为93.1%.
- 在推方案中,tNGS为73% - 86%的药物提供了完整的耐药性数据,而pDST则为92% - 93%.
- 两种tNGS溶液的灵敏度都与世卫组织推的分子测试相等或超过.
结论:
- tNGS是一个有价值的集中工具,用于全面的耐药性测试,以指导DR-TB治疗.
- 将tNGS与现有的分子测试集成,优化了诊断工作流程,以便及时和完整地检测电阻.
- 这些发现支持将tNGS纳入全球结核病诊断算法的政策更新.
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