The value of pulmonary lavage fluid ptNGS in early diagnosis and drug resistance detection of pulmonary tuberculosis
Li Wei
Yang Shuhui
Ma Haihong
Liu Zhenxi
Cao Yining
Hou Shuyan
Abstract：Objective To explore the value of targeted gene sequencing(ptNGS)of pathogens in bronchoalveolar lavage fluid(BALF)for early diagnosis and drug resistance detection of pulmonary tuberculosis(PTB).Methods 122 patients with suspected tuberculosis who underwent BALF acid fast staining smear method,cultivation of tuberculosis bacteria+drug sensitivity,MTB rpoB(RNA polymerase beta subunit)and rifampicin resistance testing(Xpert),and ptNGS testing from July 2022 to March 2024 were selected as the study subjects.The gold standard for diagnosing PTB was the clinical diagnosis result,the final diagnosis was 75 cases of PTB and 47 cases of non PTB.Compare the positive detection rates of BALF ptNGS and conventional detection methods,as well as the diagnostic efficacy of BALF ptNGS and conventional detection methods for PTB.The rifampicin resistance detected by BALF ptNGS method and its value in diagnosing rifampicin resistance.Results The positive detection rates of BALF MTB acid fast staining smear method,cultivation of tuberculosis bacteria+drug sensitivity,Xpert,and BALF ptNGS PTB were 28.00％,30.67％,20.00％,and 57.33％,respectively.The sensitivity of BALF MTB acid fast staining smear method,tuberculosis culture+drug sensitivity,Xpert,and BALF ptNGS in diagnosing PTB were 28.00％,30.67％,20.00％,and 57.33％,respectively.BALF ptNGS was higher than BALF MTB acid fast staining smear method,tuberculosis culture+drug sensitivity Xpert(x2=13.190,10.823,22.039,P＜0.05);The accuracy of BALF MTB acid fast staining smear method,tuberculosis culture+drug sensitivity,Xpert,and BALF ptNGS in diagnosing PTB were 97.87％,95.74％,95.74％,and 100.00％,respectively.BALF ptNGS was higher than BALF MTB acid fast staining smear method,tuberculosis culture+drug sensitivity Xpert(x2=9.450,8.691,15.574,P＜0.05);The area under the curve(AUC)of BALF MTB acid fast staining smear method,tuberculosis culture+drug sensitivity,Xpert,and BALF ptNGS for diagnosing PTB were 0.629,0.632,0.579,and 0.787,respectively.BALF ptNGS was higher than BALF MTB acid fast staining smear method,tuberculosis culture+drug sensitivity Xpert(Z=5.515,5.206,6.653,P＜0.05).12 cases of rifampicin resistance were detected by drug susceptibility testing,and 16 cases of rifampicin resistance were detected by BALF ptNGS method.The sensitivity of BALF ptNGS method for diagnosing rifampicin resistance was 100.00％,specificity was 93.65％,and accuracy was 94.67％.Conclusion The application value of BALF ptNGS in diagnosing PTB is superior to other conventional detection methods,and it have a high application value in diagnosing rifampicin resistance.When clinical diagnosis is difficult,joint diagnosis can be considered to improve the accuracy of detection results.
Keywords：Pulmonary tuberculosisAlveolar lavage fluidPathogen-targeted gene sequencingDiagnosisDrug resistance
Publication Date：2025-08-31
Online Publishing Date：2025-09-24(First online date of this platform, not the publication date of the document)
Pages：4( 691-694 )