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Chida Chatsopano Chozindikiritsa Chifuwa cha TB ndi Kuzindikira Kulimbana ndi Mankhwala: Kutsata Kwachibadwidwe Cha New Generation (tNGS) Kuphatikizidwa ndi Kuphunzira Kwamakina kwa Matenda a TB Hypersensitivity Diagnosis

Lipoti la Literature: CCa: njira yodziwira matenda yozikidwa pa tNGS ndi kuphunzira makina, yomwe ili yoyenera kwa anthu omwe ali ndi chifuwa chachikulu cha bakiteriya komanso chifuwa chachikulu cha TB.

Mutu wa phunziroli: Tsatanetsatane wa m'badwo wotsatira wotsata TB ndi kuphunzira pamakina: njira yowunikira kwambiri ya paucific pulmonary tubulars ndi tubular meningitis.

Periodical: 《Clinica Chimica Acta》

IFE: 6.5

Tsiku lofalitsidwa: Januware 2024

Kuphatikizidwa ndi University of Chinese Academy of Sciences ndi Beijing Chest Hospital of Capital Medical University, Macro & Micro-Test inakhazikitsa chitsanzo cha matenda a chifuwa chachikulu cha TB pogwiritsa ntchito luso lamakono lamakono (tNGS) ndi njira yophunzirira makina, zomwe zinapereka chidziwitso cha chifuwa chachikulu cha chifuwa chachikulu chokhala ndi mabakiteriya ochepa ndi chifuwa chachikulu cha chifuwa chachikulu cha TB, chinapereka njira yatsopano yodziwira matenda a chifuwa chachikulu cha chifuwa chachikulu cha chifuwa chachikulu cha matenda a chifuwa chachikulu cha TB, ndi matenda a chifuwa chachikulu cha chifuwa chachikulu cha TB. kuzindikira ndi kuchiza chifuwa chachikulu. Nthawi yomweyo, zimapezeka kuti cfDNA ya plasma ya wodwalayo ingagwiritsidwe ntchito ngati mtundu woyenera wa zitsanzo zachipatala pakuzindikira kwa TBM.

Phunziroli, zitsanzo za 227 za plasma ndi cerebrospinal fluid zinagwiritsidwa ntchito kukhazikitsa magulu awiri azachipatala, momwe zitsanzo zamagulu a labotale zidagwiritsidwa ntchito kukhazikitsa makina ophunzirira matenda a chifuwa chachikulu cha chifuwa chachikulu, ndipo zitsanzo za matenda a chipatala zinagwiritsidwa ntchito kutsimikizira chitsanzo chokhazikitsidwa. Zitsanzo zonse zidayang'aniridwa ndi dziwe lomwe linapangidwa mwapadera la Mycobacterium TB. Kenaka, pogwiritsa ntchito ndondomeko ya TB-tNGS, chitsanzo cha mtengo wa chigamulo chimagwiritsidwa ntchito popanga maulendo a 5 pamagulu ophunzitsira ndi ovomerezeka a mzere wofufuza ma laboratory, ndipo zizindikiro zowunikira zitsanzo za plasma ndi cerebrospinal fluid zitsanzo zimapezeka. Malo omwe apezeka amabweretsedwa m'mayesero awiri a mzere wozindikira matenda kuti azindikire, ndipo magwiridwe antchito a wophunzira amawunikidwa ndi ROC curve. Potsirizira pake, chitsanzo cha matenda a chifuwa chachikulu chinapezedwa.

Chithunzi cha 1 chojambula chojambula cha kafukufuku

Zotsatira: Malinga ndi malire enieni a CSF DNA sample (AUC = 0.974) ndi plasma cfDNA sample (AUC = 0.908) yotsimikiziridwa mu phunziroli, pakati pa zitsanzo 227, kukhudzika kwa chitsanzo cha CSF kunali 97.01%, kutsimikizika kwake kunali 95.65%, ndipo kukhudzidwa kwa plasma ndi 861% ya plasma ndi sampuli 61 zinali zenizeni. 86.36 %. Pakuwunika zitsanzo 44 zophatikizika za plasma cfDNA ndi cerebrospinal fluid DNA kuchokera kwa odwala a TBM, njira yodziwira matenda a kafukufukuyu imakhala ndi kusasinthika kwakukulu kwa 90.91% (40/44) mu plasma cfDNA ndi cerebrospinal fluid DNA, ndipo kukhudzika ndi 95.45% (42/44%). Ana omwe ali ndi chifuwa chachikulu cha m'mapapo mwanga, njira yodziwira matenda a phunziroli ndi yovuta kwambiri ku zitsanzo za plasma kuposa zotsatira za Xpert kudziwika kwa zitsanzo za madzi a m'mimba kuchokera kwa odwala omwewo (28,57% VS 15.38%).

Chithunzi cha 2 Kusanthula kachitidwe kachitsanzo cha matenda a chifuwa chachikulu cha anthu

Mkuyu 3 Zotsatira za matenda a zitsanzo awiriawiri

Kutsiliza: Njira yodziwira matenda a hypersensitive ya chifuwa chachikulu inakhazikitsidwa mu phunziro ili, yomwe ingapereke chida chodziwikiratu ndi chidziwitso chapamwamba kwambiri kwa odwala omwe ali ndi matenda a oligobacillary tuberculosis (chikhalidwe choyipa). Kuzindikirika kwa chifuwa chachikulu cha hypersensitive chotengera plasma cfDNA kungakhale mtundu woyenerera wozindikiritsa chifuwa chachikulu cha TB ndi TB (zitsanzo za plasma ndizosavuta kutolera kuposa cerebrospinal fluid kwa odwala omwe akuwaganizira kuti ali ndi chifuwa chachikulu muubongo).

Nkhaniyi inayamba poyamba https://www.sciencedirect.com/science/article/pii/s0009898123004990? kudzera pa%3Dihub

Kuyamba mwachidule kwa zinthu zozindikira za chifuwa chachikulu cha Macro & Micro-Test

Poganizira zovuta za zitsanzo za odwala chifuwa chachikulu ndi zosowa zosiyanasiyana, Macro & Micro-Test imapereka njira zonse za NGS zochotsa madzi kuchokera ku zitsanzo za sputum, kumanga laibulale ya Qualcomm ndi kutsatizana, ndi kusanthula deta. The mankhwala kuphimba matenda mofulumira TB odwala, mankhwala kukana kuzindikira chifuwa chachikulu, kulemba mycobacterium chifuwa chachikulu ndi NTM, hypersensitivity matenda a bakiteriya alibe chifuwa chachikulu ndi anthu chifuwa chachikulu, etc.

Zida zodziwira matenda a chifuwa chachikulu ndi mycobacteria:

Chinthu No	dzina la malonda	Kuyesa kwazinthu	mtundu wa chitsanzo	chitsanzo choyenera
HWTS-3012	Wothandizira chitsanzo	Kugwiritsidwa ntchito mu liquefaction mankhwala a sputum zitsanzo, wapeza woyamba kalasi mbiri nambala, Sutong Machinery Equipment 20230047.	makoko
HWTS-NGS-P00021	Zida zodziwira kuchuluka kwa Qualcomm za chifuwa chachikulu cha hypersensitive (njira ya probe Capture)	Kuzindikira kosasokoneza (madzi amadzimadzi) kuzindikirika kwa hypersensitivity kwa mabakiteriya omwe alibe chifuwa chachikulu cha m'mapapo ndi ma nodule a muubongo; Zitsanzo za anthu omwe amaganiziridwa kuti ali ndi chifuwa chachikulu cha TB kapena non-TB mycobacteria adawunikidwa ndi kutsata kwakuya kwa metagenomics, ndi chidziwitso chodziwikiratu ngati chifuwa chachikulu cha chifuwa chachikulu kapena chopanda chifuwa chachikulu cha mycobacteria chinali ndi kachilomboka ndipo chidziwitso chachikulu choyamba chotsutsa mankhwala cha mycobacterium TB chinaperekedwa.	Magazi ozungulira, alveolar lavage fluid, hydrothorax ndi ascites, chitsanzo cha puncture, cerebrospinal fluid.	M'badwo wachiwiri
HWTS-NGS-T001	Mycobacterium typing and drug resistance kit (multiplex amplification sequencing njira)	Mycobacterium typing test, kuphatikiza MTBC ndi 187 NTM;Kuzindikira kusagwirizana ndi mankhwala kwa chifuwa chachikulu cha Mycobacterium kumakhudza mankhwala 13 ndi malo 16 osinthika a majini osamva mankhwala.	Sputum, alveolar lavage fluid, hydrothorax ndi ascites, chitsanzo cha puncture, cerebrospinal fluid.	Wachiwiri/wachitatu m'badwo wapawiri nsanja

Mfundo zazikuluzikulu: HWTS-NGS-T001 Mycobacterium typing and drug resistance kit (njira ya multiplex amplification)

Chiyambi cha malonda

Mankhwalawa amachokera ku mankhwala akuluakulu a mzere woyamba ndi wachiwiri omwe akufotokozedwa mu malangizo a chithandizo cha WHO TB, macrolides ndi aminoglycosides omwe amagwiritsidwa ntchito kwambiri mu malangizo a mankhwala a NTM, ndipo malo omwe amatsutsana ndi mankhwala amakhudza gulu limodzi la malo okhudzana ndi mankhwala omwe ali m'ndandanda wa WHO Mycobacterium tuberculosis complex mutation catalog, komanso zina zomwe zinanenedwa kuti chibadwa cha mankhwala osokoneza bongo komanso malo osinthika amtundu wakunja ndi zolemba zapanyumba.

Chizindikiritso cha kulemba chimachokera ku zovuta za NTM zomwe zafotokozedwa mwachidule mu malangizo a NTM ofalitsidwa ndi Chinese Journal of Tuberculosis and Respiratory Diseases ndi mgwirizano wa akatswiri. Zoyambira zolembera zomwe zidapangidwa zimatha kukulitsa, kutsatizana ndikutanthauzira mitundu yopitilira 190 ya NTM.

Kupyolera mu ukadaulo waukadaulo wokulitsa wa PCR wokhazikika, jini za genotyping ndi majini osamva mankhwala a Mycobacterium adakulitsidwa ndi multiplex PCR, ndipo kuphatikiza kwa amplicon kwamitundu yomwe mukufuna kuzindikirika idapezedwa. Zogulitsa zowonjezera zimatha kumangidwa mumalaibulale amtundu wachiwiri kapena wachitatu, ndipo nsanja zonse zotsatizana za m'badwo wachiwiri ndi wachitatu zimatha kutsatiridwa mozama kwambiri kuti mupeze zambiri zotsatizana zamitundu yomwe mukufuna. Poyerekeza ndi masinthidwe odziwika omwe ali m'malo osungira omwe adamangidwa (kuphatikiza kabuku ka WHO Mycobacterium tuberculosis complex mutation ndi ubale wake ndi kukana mankhwala), masinthidwe okhudzana ndi kukana mankhwala kapena kutengeka kwa mankhwala othana ndi chifuwa chachikulu adatsimikiziridwa. Kuphatikizidwa ndi njira yodzitsegulira yokha ya sputum ya Macro & Micro-Test, vuto la kuchepa kwa nucleic acid amplification ya zitsanzo za sputum (zokwera kakhumi kuposa njira zachikale) zinathetsedwa, kotero kuti kuzindikira kusagwirizana ndi mankhwala kungagwiritsidwe ntchito mwachindunji ku zitsanzo za sputum zachipatala.

Kuzindikira kwazinthu zosiyanasiyana

34chibadwa chokhudzana ndi mankhwala kukana18anti-TB mankhwala ndi6Mankhwala a NTM adapezeka, ophimba297malo osamva mankhwala; Mitundu khumi ya chifuwa chachikulu cha Mycobacterium komanso kuposa190mitundu ya NTM idapezeka.

Gulu 1: Zambiri za 18 + 6 Mankhwala +190 + NTM

Ubwino wa mankhwala

Kusinthasintha kwamphamvu kwachipatala: zitsanzo za sputum zitha kudziwika mwachindunji ndi wodzipangira okha popanda chikhalidwe.

Ntchito yoyesera ndiyosavuta: gawo loyamba la ntchito yokulitsa ndi losavuta, ndipo ntchito yomanga laibulale imamalizidwa mu maola atatu, zomwe zimapangitsa kuti ntchitoyo ikhale yabwino.

Kulemba momveka bwino ndi kukana mankhwala: kuphimba kulemba ndi kukana mankhwala kwa MTB ndi NTM, zomwe ndi mfundo zazikuluzikulu zachipatala, kulemba molondola ndi kuzindikira kukana kwa mankhwala, kuthandizira pulogalamu yodziyimira payokha, ndikupanga malipoti owunikira ndikudina kamodzi.

Kugwirizana: kuyanjana kwazinthu, kusinthira ku nsanja za ILM ndi MGI/ONT.

Mafotokozedwe azinthu

Kodi katundu	dzina la malonda	Kuzindikira nsanja	mfundo
HWTS-NGS-T001	Mycobacterium typing and drug resistance kit (njira ya multiplex amplification)	ONT, Illumina, MGI, Salus pro	16/96 pa