背景:非结核分枝杆菌(NTM)是除结核分枝杆菌复合体(MTBC)和麻风分枝杆菌以外的分枝杆菌。NTM可在许多人体组织和器官中引起感染,最常见于肺部。临床上,非结核分枝杆菌肺病(NMLD)的症状和体征与结核病(TB)非常相似.因为大多数NTM对传统的抗结核药物有抗药性,NMLD的快速诊断是治疗的关键。本研究旨在利用基因芯片技术检测NMLD患者支气管肺泡灌洗液(BALF),探讨该技术对BALF中NMLD的快速诊断价值。
方法:回顾性分析2018年1月至2020年6月福州市肺科医院收治的NMLD患者308例。从患者收集BALF。基因芯片检测(首都生物公司,成都,中国)和BACTECMGIT960(Becton,狄金森和公司,MD,USA)进行了液体培养,以比较两种方法之间的NTM阳性检出率。通过rDNA测序鉴定从液体培养中分离的NTM菌株,并将鉴定结果与使用BALF标本的基因芯片检测结果进行比较。
结果:基因芯片法检测308例BALF标本中NTM共221例,阳性率为71.75%(221/308)。用液体培养法检测218例NTM,阳性率为70.78%(218/308)。两种方法检测BALF标本中NTM的阳性率差异无统计学意义(χ2=0.138P=0.804>0.05);187例同时进行测序和基因芯片检测,两种方法的应变识别符合率达到96.79%(181/187)。对218株NTM进行测序;鉴定出8种,前四个物种是细胞内分枝杆菌(131/218,60.09%),M.avium(48/218,22.02%),M.脓肿(27/218,12.38%),和M.kansasii(5/218,2.29%)。
结论:基因芯片技术可以快速检测BALF中的NTM,准确鉴定细菌种类。对NMLD的早期诊断和治疗具有重要的临床价值。
BACKGROUND: Nontuberculous mycobacteria (NTM) are mycobacteria other than mycobacterium tuberculosis complex (MTBC) and mycobacterium leprae. NTM can cause infection in many human tissues and organs and is most commonly seen in the lungs. Clinically, the symptoms and signs of nontuberculous mycobacteria lung disease (NMLD) are very similar to those of tuberculosis (TB). Because most NTMs are resistant to conventional anti-TB drugs, the rapid diagnosis of NMLD is the key to treatment. This study aimed to use gene chip technology to examine bronchoalveolar lavage fluid (BALF) from NMLD patients to explore the value of this technique for the rapid diagnosis of NMLD in BALF.
METHODS: A retrospective analysis of 308 patients with NMLD treated at Fuzhou Pulmonary Hospital from January 2018 to June 2020 was performed. BALF was collected from the patients. Gene chip detection (Capital Bio Corporation, Chengdu,
China) and BACTEC MGIT960 (Becton, Dickinson and Company, MD, USA) liquid culture were performed to compare the NTM positive detection rates between the two methods. The NTM strain isolated from liquid culture were identified by rDNA sequencing and the results of identification were compared with those of gene chip detection using BALF specimens.
RESULTS: A total of 221 cases of NTM were detected in 308 BALF specimens by the gene chip method; the positive rate was 71.75% (221/308). A total of 218 cases of NTM were detected by the liquid culture method, and the positive rate was 70.78% (218/308). There was no significant difference in the positive rate of NTM detected in BALF specimens between the two methods (χ2=0.138 P=0.804>0.05); 187 cases were detected with both sequencing and gene chip detection, and the coincidence rate of strain identification with the two methods reached 96.79% (181/187). Sequencing of 218 strains of NTM was carried out; eight species were identified, and the top four species were M. intracellulare (131/218, 60.09%), M. avium (48/218, 22.02%), M. abscessus (27/218, 12.38%), and M. kansasii (5/218, 2.29%).
CONCLUSIONS: Gene chip technology can rapidly detect NTM in BALF and accurately identify bacterial species. It has important clinical value in the early diagnosis and treatment of NMLD.