Chida Chatsopano Chozindikiritsa Chifuwa cha TB ndi Kuzindikira Kulimbana ndi Mankhwala: Kutsata Kutsata Kwachibadwidwe Chatsopano (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 adakhazikitsa njira yodziwira matenda a chifuwa chachikulu kutengera ukadaulo watsopano waukadaulo wotsatizana (tNGS) ndi njira yophunzirira makina, yomwe imapereka kwambiri kuzindikira kukhudzidwa kwa chifuwa chachikulu cha TB chokhala ndi mabakiteriya ochepa ndi chifuwa chachikulu cha TB, chinapereka njira yatsopano yodziwira matenda a hypersensitivity kwa matenda a mitundu iwiri ya chifuwa chachikulu cha TB, ndikuthandizira kuzindikira molondola, kuzindikira kukana mankhwala ndi kuchiza chifuwa chachikulu.Nthawi yomweyo, zimapezeka kuti cfDNA ya plasma ya wodwalayo ingagwiritsidwe ntchito ngati mtundu woyenera wa zitsanzo zachipatala pakuzindikira kwa TBM.
Pakafukufukuyu, zitsanzo za 227 za plasma ndi cerebrospinal fluid zamadzimadzi zidagwiritsidwa ntchito kukhazikitsa magulu awiri azachipatala, momwe ma laboratory diagnostic cohort cohort adagwiritsidwa ntchito kuti akhazikitse makina ophunzirira matenda a chifuwa chachikulu cha TB, ndipo zitsanzo zachipatala zidagwiritsidwa ntchito kutsimikizira zomwe zidakhazikitsidwa. matenda chitsanzo.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) yotsimikizika mu phunziroli, pakati pa zitsanzo 227, kukhudzika kwa zitsanzo za CSF kunali 97.01%, kutsimikizika kwake kunali 95.65%, ndi kukhudzika ndi kutsimikizika kwa zitsanzo za plasma zinali 82.61% ndi 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 aubongo;Zitsanzo za anthu omwe amaganiziridwa kuti ali ndi chifuwa chachikulu cha TB kapena non-TB mycobacteria adawunikidwa ndi ma metagenomics ozama kwambiri, komanso kudziwa ngati chifuwa chachikulu cha chifuwa chachikulu kapena chopanda chifuwa chachikulu cha mycobacteria chinali ndi kachilomboka komanso chidziwitso chachikulu choyamba chotsutsa mankhwala cha mycobacterium TB. zinaperekedwa. | 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 wofotokozedwa mu malangizo a chithandizo cha WHO TB, macrolides ndi aminoglycosides omwe amagwiritsidwa ntchito kwambiri mu malangizo a mankhwala a NTM, ndipo malo otsutsana ndi mankhwala amaphimba gulu limodzi la malo okhudzana ndi kukana mankhwala. Bungwe la WHO Mycobacterium tuberculosis complex mutation mutation catalogue, komanso jini zina zotsutsana ndi mankhwala komanso malo osinthika malinga ndi kafukufuku ndi ziwerengero zamabuku opambana kwambiri kunyumba ndi kunja.
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 (kuchuluka kwa khumi kuposa njira zachikale) linathetsedwa, kotero kuti kuzindikira kusagwirizana ndi mankhwala kungathe kuzindikirika. amagwiritsidwa 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 |
Nthawi yotumiza: Jan-23-2024