Yang Zhen, Liu Qian, Hu Yi, Geng Shuang, Ni Ji-Xiang
Department of Respiratory and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
Infect Drug Resist. 2025 May 3;18:2229-2241. doi: 10.2147/IDR.S514090. eCollection 2025.
To explore the application value of metagenomic next-generation sequencing (mNGS) and targeted next-generation sequencing (tNGS) in the diagnosis of pulmonary tuberculosis (PTB) in bronchoalveolar lavage fluid (BALF).
Data from 202 patients with suspected PTB at Wuhan Central Hospital (Jan 2022 - Jan 2024) were retrospectively analyzed. BALF samples were collected and examined using mNGS and tNGS, comparing their sensitivity to traditional methods like acid-fast staining, TB culture, and TB-DNA. Mixed microbial species were identified from the BALF using mNGS and tNGS, and the pros and cons of tNGS were evaluated against mNGS.
Of the 202 patients evaluated, 94 were diagnosed with PTB. The BALF mNGS and tNGS exhibited a sensitivity of 77.66% and a specificity of 100%, with positive and negative predictive values of 100% and 83.72%, respectively, outperforming conventional diagnostic methods. It was possible to compare the AUC values of the ROC curves of the BALF mNGS and tNGS with the corresponding values of the other three assay methods (0.89 vs 0.56, p < 0.05), MTB culture (0.89 vs 0.71, p < 0.05), and TB-DNA (0.89 vs 0.68, p < 0.05). Additionally, these techniques identified mixed microbial species in 52.13% of the BALF samples. Although both mNGS and tNGS demonstrated similar diagnostic rates, tNGS proved to be faster, more cost-effective, and incorporated a tuberculosis-specific wall-breaking technology, thereby suggesting greater clinical utility.
BALF mNGS and tNGS technologies quickly and accurately detect PTB patients with greater sensitivity and specificity than traditional MTB methods. While both mNGS and tNGS demonstrate enhanced capacity for polymicrobial detection, the clinical significance of co-detected microorganisms requires integration with clinical context to differentiate colonization from active infection. Compared to mNGS, tNGS provides distinct advantages in clinical utility.
探讨宏基因组下一代测序（mNGS）和靶向下一代测序（tNGS）在支气管肺泡灌洗液（BALF）中肺结核（PTB）诊断中的应用价值。
回顾性分析2022年1月至2024年1月在武汉中心医院就诊的202例疑似PTB患者的数据。收集BALF样本并使用mNGS和tNGS进行检测，将其敏感性与抗酸染色、结核培养和结核DNA等传统方法进行比较。使用mNGS和tNGS从BALF中鉴定混合微生物种类，并针对mNGS评估tNGS的优缺点。
在评估的202例患者中，94例被诊断为PTB。BALF的mNGS和tNGS敏感性为77.66%，特异性为100%，阳性预测值和阴性预测值分别为100%和83.72%，优于传统诊断方法。可以将BALF的mNGS和tNGS的ROC曲线的AUC值与其他三种检测方法（0.89对0.56，p<0.05）、MTB培养（0.89对0.71，p<0.05）和结核DNA（0.89对0.68，p<0.05）的相应值进行比较。此外，这些技术在52.13%的BALF样本中鉴定出混合微生物种类。虽然mNGS和tNGS的诊断率相似，但tNGS被证明更快、更具成本效益，并采用了结核特异性破壁技术，因此具有更大的临床实用性。
BALF的mNGS和tNGS技术比传统的MTB方法更快、更准确地检测PTB患者，敏感性和特异性更高。虽然mNGS和tNGS都显示出增强的多微生物检测能力，但共检测到的微生物的临床意义需要结合临床情况来区分定植与活动性感染。与mNGS相比，tNGS在临床实用性方面具有明显优势。
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