Diagnostic value of metagenomic next-generation sequencing in hip or knee tuberculosis

doi:10.19982/j.issn.1000-6621.20220451

Abstract

Abstract:

Objective: To investigate the value of metagenomic next generation sequencing applied (mNGS) in diagnosis of hip or knee tuberculosis. Methods: A retrospective analysis was done for 34 cases of hip or knee joint infections who were treated in Hebei Chest Hospital from June 2019 to June 2021. According to the type of pathogenic bacteria, those enrolled patients were divided into two groups: the hip or knee joint tuberculosis group (16 cases) and the non-tuberculous infection group (18 cases). The tissue samples were obtained from infected sites in all patients and were subjected to routine culture of bacteria and mycobacterium (MGIT 960 culture), the gene amplification and mNGS for detection of Mycobacterium tuberculosis DNA (MTB-DNA). The diagnostic efficacy of the three methods was compared with clinical diagnosis as the gold standard. Results: The detection rates of pathogen bacterial by mNGS was 100.0% (18/18) in non-tuberculous infection group. The positive detection rate of MTB by mNGS was 93.8% (15/16) in the joint tuberculosis group, which was higher than that of MTB-DNA amplification (50.0% (8/16)) and MGIT 960 culture (25.0% (4/16)), with significant difference (χ²=7.575, P=0.015; χ²=15.676, P=0.000). With clinical diagnosis as the gold standard, the sensitivity (93.8% (15/16)), negative predictive value (94.7% (18/19)) and Kappa value (0.942) of mNGS in the diagnosis of hip or knee tuberculosis were significantly higher than those of routine culture (25.0% (4/16), 60.0% (18/30), 0.260, respectively) and MTB-DNA amplification (50.0% (8/16), 69.2% (18/26), 0.515, respectively). But the specificity and positive predictive value of the three detection methods were 100.0%. Conclusion: mNGS can effectively identify the pathogenic bacteria of hip or knee joint infections. The mNGS has higher diagnostic efficacy in the diagnosis of joint tuberculosis and can provide important clinical guidance.

Key words: Tuberculosis, osteoarticular, Metagenomic next-generation sequencing, Diagnostic techniques and procedures, Comparative study

CLC Number:

R529.2
R8

Yao Liming, Yao Xiaowei, Dong Zhaoliang, Liu Fengsheng, Wang Lianbo, Jia Chenguang. Diagnostic value of metagenomic next-generation sequencing in hip or knee tuberculosis[J]. Chinese Journal of Antituberculosis, 2023, 45(3): 292-296. doi: 10.19982/j.issn.1000-6621.20220451

Figures/Tables 2

临床资料	关节结核组 (16例)	非结核感染性疾病组(18例)
年龄( $x ˉ$ ±s,岁)	61.07±14.53	57.88±10.11
性别[例(构成比,%)]
男性	6(37.5)	10(55.6)
女性	10(62.5)	8(44.4)
病灶位置[例(构成比,%)]
髋关节	9(56.2)	9(50.0)
膝关节	7(43.8)	9(50.0)
合并症[例(发生率,%)]
肺结核	6(37.5)	2(11.1)
慢性乙型病毒性肝炎	3(18.8)	3(16.7)
2型糖尿病	2(12.5)	2(11.1)

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检测方法	临床诊断(例)		敏感度 (%,95%CI)	特异度 (%,95%CI)	阳性预测值 (%,95%CI)	阴性预测值 (%,95%CI)	Kappa值
检测方法	阳性	阴性	敏感度 (%,95%CI)	特异度 (%,95%CI)	阳性预测值 (%,95%CI)	阴性预测值 (%,95%CI)	Kappa值
常规培养			25.0(8.3~52.6)	100.0(78.1~100.0)	100.0(39.6~100.0)	60.0(40.8~76.8)	0.260
阳性	4	0
阴性	12	18
MTB-DNA扩增			50.0(25.5~74.5)	100.0(78.1~100.0)	100.0(59.8~100.0)	69.2(48.1~84.9)	0.515
阳性	8	0
阴性	8	18
mNGS			93.8(67.7~99.7)	100.0(78.1~100.0)	100.0(74.7~100.0)	94.7(71.9~99.7)	0.942
阳性	15	0
阴性	1	18