靶向测序综合分析诊断结核分枝杆菌合并多病原体感染肺炎1例

doi:10.19871/j.cnki.xfcrbzz.2024.03.016

新发传染病电子杂志 ›› 2024, Vol. 9 ›› Issue (3): 73-77.doi: 10.19871/j.cnki.xfcrbzz.2024.03.016

靶向测序综合分析诊断结核分枝杆菌合并多病原体感染肺炎1例

刘滕颖子¹, 刘南希², 张晓敏¹, 牛丹丹³, 郭永超⁴, 王丹⁴, 林大川⁵, 李童¹, 黄嫚钰¹, 张英娈³, 张振³, 石晓路¹, 冯铁建^3,6

1.深圳市疾病预防控制中心病原微生物检测所,广东深圳 518055;
2.深圳市龙华区人民医院呼吸与危重症医学科,广东深圳 518000;
3.深圳市疾病预防控制中心传染病预防控制所,广东深圳 518000;
4.深圳联合医学科技有限公司研发部,广东深圳 518052;
5.深圳大学基础医学院,广东深圳 518060;
6.中国医学科学院深圳传染性疾病防控研究中心,广东深圳 518055

收稿日期:2024-03-05 出版日期:2024-06-30 发布日期:2024-07-23
通讯作者: 冯铁建,Email：fengtiej@126.com
基金资助:
1.深圳市医学重点学科（公共卫生重点专科）-传染病防控（SZXK064); 2.中国医学科学院中央级公益性科研院所基本科研业务费专项资金项目（2020-PT330-006）; 3.深圳市科技计划基础研究重点项目（JCYJ20200109150715644）; 4.深圳市可持续发展科技专项项目（KCXFZ202002011006190）; 5.深圳医疗卫生“三名工程”（SZSM202211023）

A case of comprehensive analysis and diagnosis of mycobacterium tuberculosis complicated with multi-pathogen pneumonia by pathogens targeted next-generation sequencing

Liu Tengyingzi¹, Liu Nanxi², Zhang Xiaomin¹, Niu Dandan³, Guo Yongchao⁴, Wang Dan⁴, Lin Dachuan⁵, Li Tong¹, Huang Manyu¹, Zhang Yingluan³, Zhang Zhen³, Shi Xiaolu¹, Feng Tiejian^3,6

1. Department of Microbiology Laboratory, Shenzhen Center for Disease Control and Prevention, Guangdong Shenzhen 518055, China;
2. Department of Pulmonary and Critical Care Medicine, Longhua District People's Hospital of Shenzhen, Guangdong Shenzhen 518000, China;
3. Department of Communicable Diseases Control and Prevention, Shenzhen Center for Disease Control and Prevention, Guangdong Shenzhen 518055, China;
4. Department of Research and Development, Shenzhen Uni-medical Techonology Co., Ltd, Guangdong Shenzhen 518052, China;
5. School of Basic Medical Science,Shenzhen University, Guangdong Shenzhen 518060, China;
6. Shenzhen Research Center for Communicable Disease Control and Prevention, Chinese Academy of Medical Sciences, Guangdong Shenzhen 518055, China

Received:2024-03-05 Online:2024-06-30 Published:2024-07-23

摘要/Abstract

摘要： 结核分枝杆菌是导致人类结核病最主要的病原体。常见的结核分枝杆菌检测方法主要有抗酸染色、罗氏培养法和γ干扰素释放试验,这些方法用于结核病的诊断耗时长且灵敏度较低,常常导致临床误诊、漏诊及治疗延误。近年来,结合多重聚合酶链反应（multiplex polymerase chain reaction,MPCR）扩增与高通量测序两种技术方法的靶向测序（targeted next-generation sequencing,tNGS）技术以其超广谱性、高灵敏度和高检出率等优点在临床检验领域受到越来越多关注,逐渐成为一种鉴定结核分枝杆菌的重要补充手段。本文报道了深圳市龙华区人民医院1例93岁男性重症肺炎患者,分析该患者治疗过程中的临床及影像学表现、病原体检测及诊疗过程,使用tNGS技术综合分析诊断,确诊为结核分枝杆菌合并多病原体混合感染,借此阐述tNGS在结核病早期诊断、混合感染识别及疾病监测和疗效评估中的潜在应用价值,提升临床对结核分枝杆菌鉴别诊断水平,同时提高临床医务工作者对于tNGS技术在感染性疾病病原鉴定中应用的认识。

关键词: 肺部感染, 重症肺炎, 结核分枝杆菌, 靶向测序

Abstract: Mycobacterium tuberculosis is the primary causative agent of human tuberculosis. Conventional detection methods for Mycobacterium tuberculosis, such as acid-fast staining and Roche culture method and Interferon gamma release assay (IGRA) , are time-consuming and have low sensitivity in diagnosing tuberculosis, often leading to clinical misdiagnosis, missed diagnosis, and treatment delays. In recent years, the integration of targeted Next-generation sequencing (tNGS) technology with Multiplex polymerase chain reaction (MPCR) amplification and high-throughput sequencing has gained increasing attention in the field of clinical testing due to its advantages of rapidity,ultra-broad spectrum, high sensitivity and high detection rate. It has gradually emerged as an important complementary approach for identifying Mycobacterium tuberculosis .This paper reported a 93-year-old male patient with severe pneumonia in the Longhua District People's Hospital of Shenzhen. The clinical manifestation, imaging examination, pathogen detection and treatment process were analyzed. The patient was finally diagnosed as Mycobacterium tuberculosis complicated with multi-pathogen infection by tNGS. tNGS showed potential value in earlier diagnosis, mixed infection identification, surveillance and therapeutic efficacy evaluation. This not only enhances the clinical differential diagnosis of Mycobacterium tuberculosis but also advances the understanding among healthcare professionals regarding the application of tNGS in pathogen identification for infectious diseases.

Key words: Lung infection, Severe pneumonia, Mycobacterium tuberculosis, Targeted Next-generation sequencing

中图分类号:

刘滕颖子, 刘南希, 张晓敏, 牛丹丹, 郭永超, 王丹, 林大川, 李童, 黄嫚钰, 张英娈, 张振, 石晓路, 冯铁建. 靶向测序综合分析诊断结核分枝杆菌合并多病原体感染肺炎1例[J]. 新发传染病电子杂志, 2024, 9(3): 73-77.

Liu Tengyingzi, Liu Nanxi, Zhang Xiaomin, Niu Dandan, Guo Yongchao, Wang Dan, Lin Dachuan, Li Tong, Huang Manyu, Zhang Yingluan, Zhang Zhen, Shi Xiaolu, Feng Tiejian. A case of comprehensive analysis and diagnosis of mycobacterium tuberculosis complicated with multi-pathogen pneumonia by pathogens targeted next-generation sequencing[J]. Electronic Journal of Emerging Infectious Diseases, 2024, 9(3): 73-77.

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靶向测序综合分析诊断结核分枝杆菌合并多病原体感染肺炎1例

A case of comprehensive analysis and diagnosis of mycobacterium tuberculosis complicated with multi-pathogen pneumonia by pathogens targeted next-generation sequencing

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