Yang Juan, Ye Wei, Zhang Chao, Lin Wenhong, Mei Lin, Liu Shengsheng, Liu Jie
Department of Tuberculosis, Anhui Chest Hospital, Anhui Provincial Institute for Tuberculosis Prevention and Treatment, Hefei 230022, China.
Department of Pathology, Anhui Chest Hospital, Anhui Provincial Institute for Tuberculosis Prevention and Treatment, Hefei 230022, China.
Trop Med Infect Dis. 2023 Sep 8;8(9):441. doi: 10.3390/tropicalmed8090441.
Early diagnosis of pulmonary tuberculosis (PTB) is pivotal for achieving effective tuberculosis (TB) control. This study aimed to assess the effectiveness of nanopore sequencing of sputum, bronchoalveolar lavage fluid (BALF), and pleural fluid samples for achieving early PTB diagnosis and provided head-to-head comparisons of nanopore sequencing results versus results obtained using smear, culture, and Xpert MTB/RIF assays. Patients admitted from October 2021 to April 2023 were screened for PTB using diagnostic imaging and electronic medical records. A total of 172 patients (129 PTB, 43 non-TB patients) were included in the final analysis after the exclusion of patients who did not meet the study's inclusion criteria. PTB-positive rates were determined for each assay, and then, assay diagnostic efficacies were compared. The positive MTB-detection rates obtained using nanopore sequencing were 86.8% for all samples, 62.3% for BALF, and 84.6% for pleural fluid, all of which were significantly higher than the corresponding rates obtained using the other three assays. The overall sensitivity rates, specificity rates, and area under the curve (AUC) values obtained from smear testing were 5.4%, 95.3%, and 0.504, respectively, as compared to the respective results obtained via culture (18.6%, 100.0%, and 0.593), Xpert MTB/RIF (26.4%, 97.7%, and 0.620), and nanopore sequencing (85.3%, 95.4%, and 0.903). The diagnostic efficacy of nanopore sequencing surpassed the diagnostic efficacies of smear, culture, and Xpert MTB/RIF assays. Thus, nanopore sequencing holds promise as an alternative to Xpert MTB/RIF for early PTB detection, particularly for the testing of BALF and pleural fluid samples.
肺结核（PTB）的早期诊断对于有效控制结核病（TB）至关重要。本研究旨在评估痰液、支气管肺泡灌洗液（BALF）和胸水样本的纳米孔测序在实现PTB早期诊断方面的有效性，并对纳米孔测序结果与涂片、培养及Xpert MTB/RIF检测结果进行直接比较。对2021年10月至2023年4月入院的患者，利用诊断性影像学检查和电子病历筛查PTB。在排除不符合研究纳入标准的患者后，共有172例患者（129例PTB患者，43例非TB患者）纳入最终分析。确定每种检测方法的PTB阳性率，然后比较各检测方法的诊断效能。纳米孔测序对所有样本的MTB阳性检出率为86.8%，对BALF为62.3%，对胸水为84.6%，均显著高于其他三种检测方法的相应检出率。涂片检测的总体灵敏度、特异度和曲线下面积（AUC）值分别为5.4%、95.3%和0.504，而培养（18.6%、100.0%和0.593）、Xpert MTB/RIF（26.4%、97.7%和0.620）及纳米孔测序（85.3%、95.4%和0.903）的相应结果与之不同。纳米孔测序的诊断效能超过了涂片、培养及Xpert MTB/RIF检测方法。因此，纳米孔测序有望成为Xpert MTB/RIF之外用于PTB早期检测的替代方法，特别是对于BALF和胸水样本的检测。
