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mNGS 与 Xpert-MTB/RIF 在肺结核诊断中的诊断价值比较：系统综述与荟萃分析
Summary
This research review compared two methods for diagnosing tuberculosis (TB), a deadly lung infection that kills more people worldwide than any other infectious disease. Scientists found that a newer genetic testing method called mNGS was better at detecting TB bacteria than the current standard test, catching 72% of cases versus 64%. Using both tests together was even more effective at 79%, which could help doctors diagnose TB faster and save more lives by starting treatment sooner.
背景：肺结核（Tuberculosis，TB）是全球病死率最高的传染性疾病，需要快速准确的病原学诊断，以便及 时阻断传播并实施早期干预，而目前新型的分子诊断方法在不同的组织中的精确性尚不明确。 方法：本研究通过系统综述，评估了宏基因组下一代测序（metagenomic next-generation sequencing, mNGS）与 Xpert-MTB/RIF 在不同样本类型中的诊断准确性。研究报告遵循 PRISMA-DTA 指南。结果：共纳入 13 项研究，评 估 mNGS 在肺组织、支气管肺泡灌洗液（bronchoalveolar lavage fluid, BALF）及活检标本中的诊断性能。双变量随 机效应荟萃分析显示，mNGS 的总体灵敏度为 72%，高于 Xpert-MTB/RIF（64%）；在 BALF 样本中，mNGS 的灵 敏度为 67%，同样高于 Xpert-MTB/RIF（56%）。此外，mNGS 与 Xpert-MTB/RIF 联合检测的灵敏度达到 79%，显 著优于任一方法单独使用（mNGS：72%；Xpert-MTB/RIF：64%）。在肺活检标本中，mNGS 表现出较高的灵敏度 （85%），而 Xpert-MTB/RIF 在该类样本中应用受限。结论：在肺组织和 BALF 样本中，mNGS 的灵敏度显著高于 Xpert-MTB/RIF。mNGS 在肺活检组织中灵敏度达 85%，而 Xpert-MTB/RIF 不适用于此类样本。mNGS 与 Xpert-MTB/RIF 联合检测的灵敏度为 79%，显著优于单一方法。mNGS 对结核病具有较高的诊断效能，尤其在灵敏 度方面表现突出，可作为快速诊断的辅助工具。与现有分子诊断方法相结合，mNGS 将在未来结核病的临床诊断中 发挥重要作用。
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