■准确、及时地诊断结核性胸膜炎是一项临床挑战,迫切需要一种快速、灵敏的诊断方法。本研究旨在评估宏基因组下一代测序(mNGS)和GeneXpert结核分枝杆菌(MTB)的诊断准确性,以鉴定结核性胸膜炎并分析结核性和非结核性胸腔积液的微生物谱。
■这项研究招募了31名疑似结核性胸膜炎患者,其中15例确诊为结核性胸膜炎,随后被分配到结核性胸膜炎组(TP组),其余16人被分配到非结核性胸膜炎组(NTP组)。对胸腔积液样本进行mNGS和GeneXpertMTB,并比较了两种测试的诊断准确性。我们采用既定的公式来计算关键指标,包括灵敏度,特异性,漏诊率,误诊率,阳性预测值(PPV),和阴性预测值(NPV)。
■结果表明,两种测试对检测结核性胸膜炎均具有高特异性(100%)和阳性预测值(100%),敏感性相当(mNGS为46.67%,GeneXpertMTB为40.0%)。对mNGS和GeneXpertMTB的联合疗效的进一步分析表明,联合检测的灵敏度为66.67%,特异性为100%。mNGS分析显示,15例结核性胸腔积液患者中有7例检测到MTB,而非结核性胸腔积液与多种微生物属和物种有关。在NTP组中,在微生物属水平上最常见的属是微杆菌属。(6/16)普雷沃氏菌属。(5/16)和弯曲杆菌。(5/16)。
■这些研究结果表明,mNGS和GeneXpertMTB是鉴别结核性胸膜炎患者的有用诊断工具,和mNGS可以为结核性和非结核性胸腔积液的微生物谱提供有价值的见解。
There is a clinical challenge in diagnosing tuberculous
pleurisy accurately and promptly, highlighting the urgent need for a rapid and sensitive diagnostic method. This
study aimed to evaluate the diagnostic accuracy of metagenomic next-generation sequencing (mNGS) and GeneXpert Mycobacterium tuberculosis (MTB) for identifying tuberculous
pleurisy and analyzing the microbial profiles of both tuberculous and non-tuberculous pleural effusions.
The
study enrolled 31 patients with suspected tuberculous
pleurisy, of which 15 were confirmed to have tuberculous
pleurisy and subsequently allocated to the tuberculous
pleurisy group (TP group), while the remaining 16 individuals were assigned to the non-tuberculous pleurisy group (NTP group). mNGS and GeneXpert MTB were performed on pleural effusion samples, and the diagnostic accuracy of both tests was compared. We employed established formulas to compute crucial indicators, including sensitivity, specificity, missed diagnosis rate, misdiagnosed rate, positive predictive value (PPV), and negative predictive value (NPV).
The results showed that both tests had high specificity (100%) and positive predictive value (100%) for detecting tuberculous pleurisy, along with comparable sensitivity (46.67% for mNGS and 40.0% for GeneXpert MTB). Further analysis of the combined efficacy of mNGS and GeneXpert MTB showed that the combined test had a sensitivity of 66.67% and a specificity of 100%. mNGS analysis revealed that MTB was detected in 7 out of 15 patients with tuberculous pleural effusions, while non-tuberculous pleural effusions were associated with a diverse range of microbial genera and species. The most frequently detected genera at the microbial genus level in the NTP group were Microbacterium spp. (6/16), Prevotella spp. (5/16), and Campylobacter spp. (5/16).
These findings suggest that mNGS and GeneXpert MTB are useful diagnostic tools for identifying patients with tuberculous pleurisy, and mNGS can provide valuable insights into the microbial profiles of both tuberculous and non-tuberculous pleural effusions.