Chida Chatsopano Chodziwira Matenda a Chifuwa Chachikulu ndi Kuzindikira Kukana Mankhwala: Kutsatana kwa Mibadwo Yatsopano (tNGS) Kophatikizidwa ndi Kuphunzira kwa Makina kwa Matenda a Chifuwa Chachikulu
Lipoti la mabuku: CCa: chitsanzo chodziwira matenda chozikidwa pa tNGS ndi kuphunzira kwa makina, chomwe chili choyenera anthu omwe ali ndi chifuwa chachikulu cha bakiteriya komanso meningitis yotupa pang'ono.
Mutu wa nkhani: Kutsatana kwa matenda a chifuwa chachikulu komanso kuphunzira kwa makina: njira yodziwira matenda a chifuwa chachikulu komanso meningitis yokhudzana ndi machubu a m'mapapo.
Periodical: 《Clinica Chimica Acta》
NGATI: 6.5
Tsiku lofalitsidwa: Januwale 2024
Pogwirizana ndi University of Chinese Academy of Sciences ndi Beijing Chest Hospital of Capital Medical University, Macro & Micro-Test inakhazikitsa njira yodziwira matenda a chifuwa chachikulu kutengera njira yatsopano yodziwira matenda (tNGS) komanso njira yophunzirira makina, yomwe inapereka chidziwitso chapamwamba kwambiri cha chifuwa chachikulu chokhala ndi mabakiteriya ochepa ndi meningitis ya chifuwa chachikulu, inapereka njira yatsopano yodziwira matenda a chifuwa chachikulu cha mitundu iwiri, ndipo inathandiza kuzindikira molondola, kuzindikira kukana mankhwala komanso kuchiza chifuwa chachikulu. Nthawi yomweyo, zapezeka kuti plasma cfDNA ya wodwalayo ingagwiritsidwe ntchito ngati mtundu woyenera wa zitsanzo zachipatala pozindikira matenda a TBM.
Mu kafukufukuyu, zitsanzo 227 za plasma ndi zitsanzo za cerebrospinal fluid zinagwiritsidwa ntchito kukhazikitsa magulu awiri azachipatala, momwe zitsanzo za labotale zowunikira matenda zinagwiritsidwa ntchito kukhazikitsa chitsanzo chophunzirira cha makina cha matenda a chifuwa chachikulu, ndipo zitsanzo za matenda a clinic diagnostic cohort zinagwiritsidwa ntchito kutsimikizira chitsanzo chodziwikiratu chodziwika bwino. Zitsanzo zonse zinayang'aniridwa koyamba ndi dziwe lofufuzira lomwe linapangidwa mwapadera la Mycobacterium tuberculosis. Kenako, kutengera deta ya TB-tNGS sequencing, chitsanzo cha mtengo wosankha chimagwiritsidwa ntchito kuchita kutsimikizira kasanu pamaphunziro ndi kutsimikizira kwa mndandanda wa matenda a labotale, ndipo malire a matenda a zitsanzo za plasma ndi zitsanzo za cerebrospinal fluid amapezeka. Malire omwe apezeka amabweretsedwa m'magulu awiri a mayeso a mndandanda wa matenda kuti azindikire, ndipo magwiridwe antchito a wophunzira amawunikidwa ndi ROC curve. Pomaliza, chitsanzo cha matenda a chifuwa chachikulu chinapezeka.
Chithunzi 1 chithunzi cha kapangidwe ka kafukufuku
Zotsatira: Malinga ndi malire enieni a chitsanzo cha CSF DNA (AUC = 0.974) ndi chitsanzo cha plasma cfDNA (AUC = 0.908) chomwe chapezeka mu kafukufukuyu, pakati pa zitsanzo 227, kukhudzidwa kwa chitsanzo cha CSF kunali 97.01%, kudziwika kwake kunali 95.65%, ndipo kukhudzidwa ndi kudziwika kwa chitsanzo cha plasma kunali 82.61% ndi 86.36%. Mu kusanthula zitsanzo 44 zophatikizana za plasma cfDNA ndi DNA yamadzimadzi a m'mitsempha kuchokera kwa odwala a TBM, njira yodziwira matenda ya kafukufukuyu ili ndi kukhazikika kwakukulu kwa 90.91% (40/44) mu plasma cfDNA ndi DNA yamadzimadzi a m'mitsempha, ndipo kukhudzidwa kwake ndi 95.45% (42/44). Mwa ana omwe ali ndi chifuwa chachikulu cha m'mapapo, njira yodziwira matenda ya kafukufukuyu imakhala yodziwika kwambiri ndi zitsanzo za plasma kuposa zotsatira za Xpert zozindikira zitsanzo za madzi am'mimba kuchokera kwa odwala omwewo (28.57% VS 15.38%).
Chithunzi 2 Kusanthula momwe chitsanzo cha matenda a chifuwa chachikulu chimagwirira ntchito pa zitsanzo za anthu
Chithunzi 3 Zotsatira za matenda a zitsanzo zophatikizana
Pomaliza: Njira yodziwira chifuwa chachikulu yakhazikitsidwa mu kafukufukuyu, yomwe ingapereke chida chodziwira matenda chomwe chingathandize kwambiri odwala omwe ali ndi chifuwa chachikulu cha oligobacillary (negative culture). Kuzindikira chifuwa chachikulu chochokera ku plasma cfDNA kungakhale mtundu woyenera wa chitsanzo chodziwira chifuwa chachikulu chogwira ntchito komanso chifuwa chachikulu cha meningitis (zitsanzo za plasma ndizosavuta kusonkhanitsa kuposa madzi a m'mitsempha ya ubongo kwa odwala omwe akuganiziridwa kuti ali ndi chifuwa chachikulu cha ubongo).
Ulalo woyambirira: https://www.sciencedirect.com/science/article/pii/s0009898123004990? via%3Dihub
Kufotokozera mwachidule za zinthu zodziwira chifuwa chachikulu cha Macro & Micro-Test
Poganizira za zovuta zomwe zimachitika kwa odwala chifuwa chachikulu komanso zosowa zosiyanasiyana, Macro & Micro-Test imapereka njira zonse za NGS zochotsera madzi kuchokera ku zitsanzo za makoswe, kupanga ndi kutsata laibulale ya Qualcomm, komanso kusanthula deta. Zogulitsazi zimaphatikizapo kuzindikira mwachangu odwala chifuwa chachikulu, kuzindikira chifuwa chachikulu chomwe sichimalandira mankhwala, kuyika mycobacterium tuberculosis ndi NTM, kuzindikira matenda a chifuwa chachikulu chomwe sichili ndi mabakiteriya komanso anthu omwe ali ndi chifuwa chachikulu, ndi zina zotero.
Zipangizo zodziwira chifuwa chachikulu ndi mabakiteriya a mycobacteria:
| Nambala ya Chinthu | dzina la chinthu | zomwe zili mu kuyesa zinthu | mtundu wa chitsanzo | chitsanzo choyenera |
| HWTS-3012 | Chitsanzo chotulutsira | Pogwiritsidwa ntchito pochiza madzi oundana a zitsanzo za sputum, yapeza nambala yodziwika bwino, Sutong Machinery Equipment 20230047. | sputum | |
| HWTS-NGS-P00021 | Chida chodziwira kuchuluka kwa Qualcomm cha chifuwa chachikulu chomwe chimayambitsa matenda (njira yofufuzira) | Kuzindikira matenda osalowa m'thupi (biopsy yamadzimadzi) a chifuwa chachikulu cha m'mapapo ndi timitsempha ta ubongo tomwe sitili ndi mabakiteriya; Zitsanzo za anthu omwe akuganiziridwa kuti ali ndi kachilombo ka chifuwa chachikulu kapena mycobacteria yosakhala ya chifuwa chachikulu zinawunikidwa pogwiritsa ntchito njira yowunikira mozama, ndipo chidziwitso chozindikira ngati chifuwa chachikulu kapena mycobacteria yosakhala ya chifuwa chachikulu inali ndi kachilomboka komanso chidziwitso chachikulu chotsutsana ndi mankhwala cha mycobacterium tuberculosis chinaperekedwa. | Magazi a m'mphepete mwa nyanja, madzi osambira a alveolar, hydrothorax ndi ascites, chitsanzo cha kupunthwa kolunjika, madzi a m'mitsempha ya ubongo. | Mbadwo wachiwiri |
| HWTS-NGS-T001 | Mycobacterium typing ndi drug resistance detection kit (njira yotsatirira kuchuluka kwa ma amplification) | Mayeso a Mycobacterium typing, kuphatikizapo MTBC ndi 187 NTM；Kuzindikira matenda a Mycobacterium TB osagwiritsa ntchito mankhwala kumaphatikizapo mankhwala 13 ndi malo 16 ofunikira a majini osagwiritsa ntchito mankhwala. | Makoswe, madzi osambira a alveolar, hydrothorax ndi ascites, chitsanzo cha kupunthwa kwa focus, madzi a m'mitsempha ya ubongo. | Nsanja yachiwiri/yachitatu ya mibadwo iwiri |
Zofunika Kwambiri: HWTS-NGS-T001 Mycobacterium typing ndi drug resistance detection kit (njira yowonjezera ya multiplex)
Chiyambi cha malonda
Mankhwalawa akuchokera pa mankhwala akuluakulu oyamba ndi achiwiri omwe afotokozedwa mu malangizo a WHO TB, ma macrolides ndi aminoglycosides omwe amagwiritsidwa ntchito kwambiri mu malangizo a NTM, ndipo malo okana mankhwala amakhudza gulu limodzi la malo okhudzana ndi kukana mankhwala mu kabukhu ka WHO Mycobacterium tuberculosis complex mutation, komanso majini ena okana mankhwala ndi malo osinthira malinga ndi kafukufuku ndi ziwerengero za mabuku apamwamba kwambiri kunyumba ndi kunja.
Kuzindikira mitundu ya NTM kumadalira mitundu ya NTM yomwe yafotokozedwa m'malangizo a NTM omwe adafalitsidwa ndi Chinese Journal of Tuberculosis and Respiratory Diseases komanso akatswiri omwe amagwirizana. Ma primer olembera omwe adapangidwa amatha kukulitsa, kutsata ndi kufotokoza mitundu yoposa 190 ya NTM.
Kudzera mu ukadaulo wowunikira wa multiplex PCR, majini oyambitsa majini ndi majini osagwira mankhwala a Mycobacterium adakulitsidwa ndi multiplex PCR, ndipo kuphatikiza kwa amplicon kwa majini omwe akuyenera kuzindikirika kunapezeka. Zogulitsa zomwe zakulitsidwa zitha kupangidwa kukhala malaibulale owerengera a m'badwo wachiwiri kapena wachitatu, ndipo nsanja zonse zowerengera za m'badwo wachiwiri ndi wachitatu zitha kuyesedwa mozama kuti zipeze zambiri za majini omwe akuyenera kuzitsatira. Poyerekeza ndi masinthidwe odziwika omwe ali mu database yolumikizidwa (kuphatikiza kabukhu ka WHO ka Mycobacterium tuberculosis complex mutation ndi ubale wake ndi kukana mankhwala), masinthidwe okhudzana ndi kukana mankhwala kapena kuthekera kwa mankhwala oletsa chifuwa chachikulu adadziwika. Kuphatikiza ndi yankho lodzitsegulira lokha la Macro & Micro-Test, vuto la kuchepa kwa nucleic acid amplification ya zitsanzo za sputum zachipatala (zokwera kakhumi kuposa njira zachikhalidwe) linathetsedwa, kotero kuti kuzindikira kukana mankhwala kungagwiritsidwe ntchito mwachindunji ku zitsanzo za sputum zachipatala.
Kuzindikira zinthu zosiyanasiyana
34majini okhudzana ndi kukana mankhwala18mankhwala oletsa chifuwa chachikulu ndi6Mankhwala a NTM adapezeka, omwe amaphimba297malo osagwiritsa ntchito mankhwala; Mitundu khumi ya chifuwa chachikulu cha Mycobacterium ndi zina zoposa190Mitundu ya NTM yapezeka.
Gome 1: Chidziwitso cha Mankhwala Osokoneza Bongo a Zaka 18+6 +190+NTM
Ubwino wa malonda
Kusinthasintha kwamphamvu kwachipatala: zitsanzo za makoswe zimatha kuzindikirika mwachindunji ndi mankhwala odzipangira okha popanda kukulitsa.
Ntchito yoyesera ndi yosavuta: gawo loyamba la ntchito yokulitsa ndi losavuta, ndipo kumanga laibulale kumatha mu maola atatu, zomwe zimapangitsa kuti ntchitoyo ikhale yogwira mtima.
Kulemba ndi kukana mankhwala: kufotokoza malo olembera ndi kukana mankhwala a MTB ndi NTM, omwe ndi mfundo zofunika kwambiri zachipatala, kuzindikira molondola kukana mankhwala, kuthandizira pulogalamu yodziyimira payokha yowunikira, ndikupanga malipoti owunikira ndi kudina kamodzi.
Kugwirizana: kugwirizana kwa malonda, kusintha malinga ndi nsanja zazikulu za ILM ndi MGI/ONT.
Mafotokozedwe a malonda
| Khodi ya chinthu | dzina la chinthu | Nsanja yodziwira | zofunikira |
| HWTS-NGS-T001 | Mycobacterium typing ndi drug resistance kit (njira yowonjezera ma multiplex) | ONT, Illumina, MGI, Salus pro | 16/96rxn |
Nthawi yotumizira: Januwale-23-2024