The Clinical Application Value of Second-Generation Sequencing of Bronchoalveolar Lavage Fluid in the Diagnosis and Differential Diagnosis of Suspected Pulmonary Tuberculosis Patients
Objective To evaluate the clinical application value of bronchoalveolar lavage fluid(BALF)inspection for Second-generation sequencing(NGS)in the diagnosis and differential diagnosis of patients with negative sputum acid-fast staining and suspected pulmonary tuberculosis.Methods Using a cross-sectional study design and simple random sampling method,a total of 138 patients who underwent bronchoscopy examination for negative sputum acid-fast staining and suspected pulmonary tuberculosis in the Department of Respiratory Medicine of Ningxia Hui Autonomous Region People's Hospital from January 2023 to November 2023 were collected.The clinical data,imaging findings,bronchoscopic findings,BALF NGS,tuberculosis DNA(TB-DNA),and other results were statistically analyzed.Results Among the 138 suspected pulmonary tuberculosis patients collected,43 cases were excluded due to incomplete clinical data.Finally,95 patients were included in the analysis,including 53 cases diagnosed as active pulmonary tuberculosis and 42 cases excluded from pulmonary tuberculosis diagnosis.The clinical manifestations of the two groups of patients were hemoptysis and/or bloody sputum,with imaging showing the tree bud sign.Under bronchoscopy,the symptoms were charcoal deposition,mucosal inflammation,luminal occlusion,and white discharge.The differences were statistically significant(P all＜0.05).In terms of diagnosing active pulmonary tuberculosis,the sensitivity of NGS was higher than that of TB-DNA(60.4％vs 50.9％).The specificity is as high as 92.9％,higher than TB-DNA(85.7％).Meanwhile,NGS also detected 16 cases of mixed infections of active pulmonary tuberculosis with other pathogens.In terms of differential diagnosis of the 42 patients excluded from pulmonary tuberculosis,NGS detected pathogens other than Mycobacterium tuberculosis in 26 cases(26/42,61.9％),including 9 cases of non-tuberculous mycobacteria,8 cases of fungi,5 cases of Mycoplasma pneumoniae infection,and 4 cases of Staphylococcus aureus infection.Conclusion NGS of BALF is more sensitive than TB-DNA in diagnosing pulmonary tuberculosis.It is beneficial for early diagnosis of suspected pulmonary tuberculosis patients with negative sputum acid-fast staining.Meanwhile,for suspected pulmonary tuberculosis patients with negative sputum smears,NGS can quickly identify other pathogens such as non-tuberculous mycobacteria and fungi.
万方数据
维普
