Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Hefei, 230001, Anhui, China.
Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, Anhui, China.
BMC Pulm Med. 2022 Jul 28;22(1):288. doi: 10.1186/s12890-022-02079-8.
BACKGROUND: Tuberculosis (TB) is a chronic infectious disease caused by the Mycobacterium tuberculosis complex (MTBC), which is the leading cause of death from infectious diseases. The rapid and accurate microbiological detection of the MTBC is crucial for the diagnosis and treatment of TB. Metagenomic next-generation sequencing (mNGS) has been shown to be a promising and satisfying application of detection in infectious diseases. However, relevant research about the difference in MTBC detection by mNGS between bronchoalveolar lavage fluid (BALF) and lung biopsy tissue specimens remains scarce. METHODS: We used mNGS to detect pathogens in BALF and lung biopsy tissue obtained by CT-guide percutaneous lung puncture (CPLP) or radial endobronchial ultrasound transbronchial lung biopsy (R-EBUS-TBLB) from 443 hospitalized patients in mainland China suspected of pulmonary infections between May 1, 2019 and October 31, 2021. Aim to evaluate the diagnostic performance of mNGS for detecting MTBC and explore differences in the microbial composition in the 2 specimen types. RESULTS: Among the 443 patients, 46 patients finally were diagnosed with TB, of which 36 patients were detected as MTBC positive by mNGS (8.93%). Striking differences were noticed in the higher detection efficiency of lung biopsy tissue compared with BALF (P = 0.004). There were no significant differences between the 2 specimen types in the relative abundance among the 27 pathogens detected by mNGS from the 36 patients. CONCLUSIONS: This study demonstrates that mNGS could offer an effective detection method of MTBC in BALF or lung tissue biopsy samples in patients suspected of TB infections. When it comes to the situations that BALF samples have limited value to catch pathogens for special lesion sites or the patients have contraindications to bronchoalveolar lavage (BAL) procedures, lung biopsy tissue is an optional specimen for MTBC detection by mNGS. However, whether lung tissue-mNGS is superior to BALF-mNGS in patients with MTBC infection requires further prospective multicenter randomized controlled studies with more cases.
背景：结核病（TB）是由结核分枝杆菌复合群（MTBC）引起的慢性传染病，是传染病死亡的主要原因。MTBC 的快速准确微生物检测对于 TB 的诊断和治疗至关重要。宏基因组下一代测序（mNGS）已被证明是一种有前途和令人满意的传染病检测应用。然而，关于 mNGS 在支气管肺泡灌洗液（BALF）和经 CT 引导经皮肺穿刺（CPLP）或径向支气管内超声经支气管肺活检（R-EBUS-TBLB）获得的肺活检组织标本中检测 MTBC 的差异的相关研究仍然很少。
方法：我们使用 mNGS 检测 2019 年 5 月 1 日至 2021 年 10 月 31 日期间中国大陆 443 例疑似肺部感染住院患者的 BALF 和经 CT 引导经皮肺穿刺（CPLP）或经径向支气管内超声经支气管肺活检（R-EBUS-TBLB）获得的肺活检组织中的病原体。旨在评估 mNGS 检测 MTBC 的诊断性能，并探讨 2 种标本类型中微生物组成的差异。
结果：在 443 名患者中，最终有 46 名患者被诊断为结核病，其中 36 名患者的 mNGS 检测结果为 MTBC 阳性（8.93%）。肺活检组织的检测效率明显高于 BALF（P=0.004）。在 mNGS 从 36 名患者检测到的 27 种病原体中，2 种标本类型之间的相对丰度没有显著差异。
结论：本研究表明，mNGS 可为疑似 TB 感染患者的 BALF 或肺组织活检样本提供有效的 MTBC 检测方法。当 BALF 样本对特殊病变部位的病原体捕获价值有限或患者对支气管肺泡灌洗（BAL）程序有禁忌时，肺活检组织是 mNGS 检测 MTBC 的可选标本。然而，在 MTBC 感染患者中，肺组织-mNGS 是否优于 BALF-mNGS，还需要更多病例的前瞻性多中心随机对照研究来进一步证实。
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