Diagnostic Valueof Bronchial Lavage Fluid Smear，Mycobacterium Tuberculosis Culture，Real-time FluorogenicQuantitativePCRand tNGS in BacteriologicalNegative Pulmonary Tuberculosis/LUOBin，JI Guijuan，HE Meiling.//Medical Innovationof China，2025，22（16）：142-146

[Abstract]Objective： To investigate the diagnostic value of bronchial lavage fluid smear， Mycobacterium tuberculosis culture，real-time fluorogenic quantitative polymerase chain reaction （PCR），and targeted nextgeneration sequencing （tNGS）for bacteriological negative pulmonary tuberculosis.Method： A total of 8O patients diagnosed with bacteriological negative pulmonary tuberculosis admited to Shangrao Municipal Hospital from March 202O to May 2O23 were retrospectively selected and included in the study group，another 8O patients with lung disease admited toour hospital during the same period wereselected and included as the control group.The patients in both groups received bronchoscopy，obtained bronchial lavage fluid samples，and bronchial lavage fluid smear，Mycobacterium tuberculosis culture，real-time fluorogenic quantitative PCR，tNGS were detected. The consistencyand efcacyof the four detection methods in the diagnosis of bacteriological negative pulmonary tuberculosis were compared.Result： Among the 16O patients，78 cases were positive by real-time fluorogenic quantitative PCR，89 cases were positive by tNGS，62 cases were positive by Mycobacterium tuberculosis culture，and 7O cases were positive by bronchial lavage fluid smear.The sensitivities of real-time fluorogenic quantitative PCR，tNGS，Mycobacterium tuberculosis culture and bronchial lavage fluid smear in the diagnosis of bacteriological negative pulmonary tuberculosis were 76.25% ， 100% ，43.75 % and 65.00% ，respectively， the specificity were 78.75 % ，88.75 % ，66.25 % and 77.50% ，respectively，and the accuracy were 77.50% ， 94.38% （20 55.00% ， 71.25% ，respectively. The consistency between tNGS and the gold standard was the highest， with a Kappa value of O.944，and the Kappa value of bronchial lavage fluid smear，Mycobacterium tuberculosis culture and realtimefluorogenic quantitative PCR were 0.425，O.1OO and0.55O，respectively.Thesensitivity，positive predictive value，negative predictive value and accuracyof tNGS weresignificantlyhigherthan those of bronchial lavage fluid smear，Mycobacterium tuberculosis culture and real-time fluorogenic quantitative PCR （ P lt;0.05）. The specificity of tNGS was higher than that of Mycobacterium tuberculosis culture （ P lt;0.05）.Conclusion：Bronchial lavage fluid smear，Mycobacterium tuberculosis culture，real-time fluorogenic quantitative PCRand tNGS detection have certaindiagnosticeffectsonbacteriologicalnegativepulmonary tuberculosis，amongwhichtNGSdetectionhas high sensitivity and specificity.

[KeyWords] Bronchial lavage fluid smearMycobacterium tuberculosis cultureReal-time fluorogenic quantitative polymerase chain reaction Targeted next-generation sequencing Bacteriological negative pulmonary tuberculosis

First-author's address： Department of RespiratoryMedicine，Shangrao Municipal Hospital，Shangrao ， China

doi：10.3969/j.issn.1674-4985.2025.16.034

肺结核是指因结核分枝杆菌感染所致的一类呼吸系统疾病，主要发生在肺组织、支气管、胸膜等部位，具有较强传染性，属于我国乙类传染病。有资料统计，我国肺结核发病具有季节性和循环周期性，一般春季发病率高，且高密度地区和人群流动性较大的地区分布广{]。其起病缓慢，早期症状不明显，部分患者属于非活动期肺结核或潜伏感染者，不易诊断，若未得到及时诊断治疗，不仅增强传染性，加大结核防控难度，严重者还会导致死亡[2。因此，提高临床诊断准确性对制订治疗方案及传染病防控工作十分重要。菌阴肺结核是指至少3次痰涂片及1次痰培养为阴性，但患者临床表现及其他检查均符合肺结核症状的活动性肺结核。菌阴肺结核常见于肺结核发病早期阶段，相较于菌阳肺结核，其结核分枝杆菌的检出率较低或完全没有，虽然传染性较小，但潜在风险大，后期阴转阳则会表现出发热、咳嗽、咯血等症状，延误病情，对患者预后造成不良影响[3]。因此加强对菌阴肺结核的特异性诊断十分必要。目前临床对菌阴肺结核的检测方式较多，如支气管灌洗液涂片、结核分枝杆菌培养、实时荧光定量聚合酶链式反应（polymerasechainreaction，PCR）、靶向基因测序（targeted next-generation sequencing，tNGS）等[4-5]，但对不同检测方式的诊断效果比较尚缺乏充分的高质量文献或资料佐证。为进一步探讨不同检测方式对菌阴肺结核的诊断价值，本研究进行回顾性分析，以上饶市立医院80例菌阴肺结核患者为研究对象，探讨并比较支气管灌洗液涂片、结核分枝杆菌培养、实时荧光定量PCR及tNGS对菌阴肺结核的诊断价值，具体报道如下。……