Yu Guocan, Shen Yanqin, Zhong Fangming, Zhou Lihong, Chen Gang, Fang Likui, Zhu Pengfei, Sun Lifang, Zhao Wuchen, Yu Wenfeng, Ye Bo
Zhejiang Tuberculosis Diagnosis and Treatment Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Zhejiang Tuberculosis Diagnosis and Treatment Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Int J Infect Dis. 2022 Sep;122:237-243. doi: 10.1016/j.ijid.2022.06.001. Epub 2022 Jun 6.
The aim of this study was to assess the role of nanopore sequencing using respiratory specimens in the early diagnosis of pulmonary tuberculosis (PTB) and simultaneously compare it head-to-head with Mycobacterium tuberculosis (MTB) culture, and Xpert MTB/rifampin (RIF).
The clinical data of 164 patients with suspected PTB were retrospectively reviewed to determine the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of the acid-fast bacilli (AFB) smear, MTB culture, Xpert MTB/RIF, and nanopore sequencing and assess their diagnostic accuracy compared with culture combined with clinical diagnosis.
The overall sensitivity, specificity, PPV, NPV, and AUC of the AFB smear were 27.6%, 87.5%, 84.2%, 33.3%, and 0.58, respectively; for MTB culture, these values were 57.8%, 100.0%, 100.0%, 49.5%, and 0.79, respectively; for Xpert MTB/RIF, these values were 62.9%, 97.9%, 98.7%, 52.2%, and 0.80, respectively; and for nanopore sequencing, these values were 94.8%, 97.9%, 99.1%, 88.7%, and 0.96, respectively.
The diagnostic accuracy of nanopore sequencing was excellent in terms of PTB diagnosis and was considerably better than that of the Xpert MTB/RIF and MTB culture. Nanopore sequencing could be an effective alternative to Xpert MTB/RIF for the initial detection of PTB to improve the accuracy of PTB diagnosis.
本研究旨在评估使用呼吸道标本进行纳米孔测序在肺结核（PTB）早期诊断中的作用，并同时将其与结核分枝杆菌（MTB）培养及Xpert MTB/利福平（RIF）进行直接比较。
回顾性分析164例疑似PTB患者的临床资料，以确定抗酸杆菌（AFB）涂片、MTB培养、Xpert MTB/RIF及纳米孔测序的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和曲线下面积（AUC），并与培养结合临床诊断相比较，评估其诊断准确性。
AFB涂片的总体敏感性、特异性、PPV、NPV和AUC分别为27.6%、87.5%、84.2%、33.3%和0.58；MTB培养的这些值分别为57.8%、100.0%、100.0%、49.5%和0.79；Xpert MTB/RIF的这些值分别为62.9%、97.9%、98.7%、52.2%和0.80；纳米孔测序的这些值分别为94.8%、97.9%、99.1%、88.7%和0.96。
纳米孔测序在PTB诊断方面的诊断准确性极佳，明显优于Xpert MTB/RIF和MTB培养。纳米孔测序可作为Xpert MTB/RIF用于PTB初始检测以提高PTB诊断准确性的有效替代方法。
