Nishii Yoichi, Furuhashi Kazuki, Nakamura Saki, Nishio Miho, Nakamura Yuki, Ushiro Kengo, Ito Kentaro, Sakaguchi Tadashi, Suzuki Yuta, Fujiwara Kentaro, Yasuma Taro, Kobayashi Tetsu, D'Alessandro-Gabazza Corina, Gabazza Esteban C, Taguchi Osamu, Hataji Osamu
Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Mie, Japan.
Department of Immunology, Faculty and Graduate School of Medicine, Mie University, Tsu-city, Mie, Japan.
Infect Drug Resist. 2021 Dec 1;14:5079-5087. doi: 10.2147/IDR.S338165. eCollection 2021.
Many patients with nontuberculous mycobacteria pulmonary disease are asymptomatic. The disease diagnosis is confirmed in only a small proportion of patients with radiological findings suspicious for nontuberculous mycobacteria pulmonary disease. Thus, many patients remained undiagnosed. Here, we evaluated the diagnostic value of digital polymerase chain reaction (PCR) in nontuberculous mycobacteria pulmonary disease.
We prospectively evaluated 123 patients with radiological findings suspicious for nontuberculous mycobacteria pulmonary disease. Digital PCR was performed using bronchial lavage fluid, sputum, saliva, blood, and urine.
The culture of bronchial washing fluid was positive for nontuberculous mycobacteria in 53 patients and negative in 70. The positive detection rate of nontuberculous mycobacteria by digital PCR in patients with positive culture (n = 53) was as follows: bronchial lavage fluid 100%, sputum 62.9%, saliva 41.5%, blood 7.5%, and urine 3.8%. All patients with two or more positive partitions for nontuberculous mycobacteria in the digital PCR of bronchial lavage fluid showed nontuberculous mycobacteria growth in the bronchial lavage fluid culture. The digital PCR analysis of the bronchial lavage fluid showed a high sensitivity (100%), specificity (85.7%), positive predictive value (84.1%), negative predictive value (100%), and a high concordance rate (91.9%) with the bronchial lavage fluid culture results. In addition, the culture of bronchial lavage fluid was positive for nontuberculous mycobacteria in patients with two or more positive partitions in the digital PCR of sputum and saliva with a combined positive predictive value of 81.1%.
Digital PCR analysis of nontuberculous mycobacteria in bronchial lavage fluid shows a high concordance rate with the bronchial lavage fluid culture results and a high positive predictive value using both sputum and saliva, suggesting the potential usefulness of dPCR for diagnosis of nontuberculous mycobacteria pulmonary disease in clinical practice.
许多非结核分枝杆菌肺病患者无症状。在仅有少量放射学表现可疑为非结核分枝杆菌肺病的患者中确诊了该病。因此，许多患者仍未被诊断出来。在此，我们评估了数字聚合酶链反应（PCR）在非结核分枝杆菌肺病中的诊断价值。
我们前瞻性地评估了123例放射学表现可疑为非结核分枝杆菌肺病的患者。使用支气管灌洗液、痰液、唾液、血液和尿液进行数字PCR检测。
支气管冲洗液培养出非结核分枝杆菌的患者有53例，培养阴性的有70例。培养阳性（n = 53）患者中数字PCR检测非结核分枝杆菌的阳性检出率如下：支气管灌洗液100%，痰液62.9%，唾液41.5%，血液7.5%，尿液3.8%。支气管灌洗液数字PCR中出现两个或更多非结核分枝杆菌阳性分区的所有患者，其支气管灌洗液培养均显示有非结核分枝杆菌生长。支气管灌洗液的数字PCR分析显示出高敏感性（100%）、特异性（85.7%）、阳性预测值（84.1%）、阴性预测值（100%），并且与支气管灌洗液培养结果的一致性率很高（91.9%）。此外，痰液和唾液数字PCR中有两个或更多阳性分区的患者，其支气管灌洗液培养出非结核分枝杆菌，联合阳性预测值为81.1%。
支气管灌洗液中非结核分枝杆菌的数字PCR分析与支气管灌洗液培养结果的一致性率很高，并且使用痰液和唾液时阳性预测值也很高，这表明数字PCR在临床实践中诊断非结核分枝杆菌肺病具有潜在的实用性。
