Abstract：
OBJECTIVE: To explore the diagnostic value of third-generation nanopore sequencing technology in patients with diabetes mellitus suspected of pulmonary tuberculosis.
METHODS: Samples, including sputum and bronchoalveolar lavage fluid(BALF), were collected from patients with diabetes mellitus suspected of pulmonary tuberculosis who were admitted from October 2021 to August 2023. Nanopore sequencing, acid-fast bacilli (AFB) smear, mycobacterial solid culture, Xpert MTB/RIF, and DNA detection were performed, and their diagnostic efficacy was compared.
RESULTS: Third-generation nanopore sequencing technology exhibited high accuracy in diagnosing pulmonary tuberculosis in patients with diabetes mellitus. Compared to traditional methods, nanopore sequencing showed significantly improved sensitivity (76.80 %), negative predictive value (30.40 %), coincidence (77.92 %), and diagnostic accuracy (AUC = 0.822). Combined detection with Xpert achieved the highest diagnostic performance, with increased sensitivity (81.20 %), positive predictive value (98.20 %), negative predictive value (35.00 %), coincidence (81.82 %), and AUC (0.843). Although acid-fast staining had limitations, its combination with nanopore sequencing improved screening effectiveness.
CONCLUSIONS: Compared to established diagnostic modalities such as acid-fast staining, mycobacterial solid culture, Xpert MTB/RIF, and DNA detection, third-generation nanopore sequencing technology demonstrates a significant improvement in sensitivity for detecting suspected pulmonary tuberculosis in diabetic patients. Notably, the combined application of nanopore sequencing with Xpert testing offers a further enhancement in diagnostic accuracy.
METHODS: Samples, including sputum and bronchoalveolar lavage fluid(BALF), were collected from patients with diabetes mellitus suspected of pulmonary tuberculosis who were admitted from October 2021 to August 2023. Nanopore sequencing, acid-fast bacilli (AFB) smear, mycobacterial solid culture, Xpert MTB/RIF, and DNA detection were performed, and their diagnostic efficacy was compared.
RESULTS: Third-generation nanopore sequencing technology exhibited high accuracy in diagnosing pulmonary tuberculosis in patients with diabetes mellitus. Compared to traditional methods, nanopore sequencing showed significantly improved sensitivity (76.80 %), negative predictive value (30.40 %), coincidence (77.92 %), and diagnostic accuracy (AUC = 0.822). Combined detection with Xpert achieved the highest diagnostic performance, with increased sensitivity (81.20 %), positive predictive value (98.20 %), negative predictive value (35.00 %), coincidence (81.82 %), and AUC (0.843). Although acid-fast staining had limitations, its combination with nanopore sequencing improved screening effectiveness.
CONCLUSIONS: Compared to established diagnostic modalities such as acid-fast staining, mycobacterial solid culture, Xpert MTB/RIF, and DNA detection, third-generation nanopore sequencing technology demonstrates a significant improvement in sensitivity for detecting suspected pulmonary tuberculosis in diabetic patients. Notably, the combined application of nanopore sequencing with Xpert testing offers a further enhancement in diagnostic accuracy.
摘要：
目的：探讨第三代纳米孔测序技术在糖尿病合并疑似肺结核患者中的诊断价值。
方法：样品，包括痰和支气管肺泡灌洗液（BALF），从2021年10月至2023年8月收治的疑似肺结核的糖尿病患者中收集。纳米孔测序，抗酸杆菌（AFB）涂片，分枝杆菌固体培养，XpertMTB/RIF,并进行DNA检测，并比较其诊断效能。
结果：第三代纳米孔测序技术在糖尿病患者肺结核诊断中具有很高的准确性。与传统方法相比，纳米孔测序显示灵敏度显著提高（76.80%），阴性预测值（30.40%），巧合（77.92%），和诊断准确性（AUC=0.822）。结合Xpert检测实现了最高的诊断性能，灵敏度提高（81.20%），阳性预测值（98.20%），阴性预测值（35.00%），巧合(81.82%)，和AUC（0.843）。尽管抗酸染色有局限性，其与纳米孔测序的结合提高了筛查的有效性。
结论：与已建立的诊断方法如耐酸染色相比，分枝杆菌固体培养，XpertMTB/RIF,和DNA检测，第三代纳米孔测序技术显示,在糖尿病患者中检测疑似肺结核的敏感性显著提高.值得注意的是,纳米孔测序与Xpert检测的联合应用进一步提高了诊断准确性.
方法：样品，包括痰和支气管肺泡灌洗液（BALF），从2021年10月至2023年8月收治的疑似肺结核的糖尿病患者中收集。纳米孔测序，抗酸杆菌（AFB）涂片，分枝杆菌固体培养，XpertMTB/RIF,并进行DNA检测，并比较其诊断效能。
结果：第三代纳米孔测序技术在糖尿病患者肺结核诊断中具有很高的准确性。与传统方法相比，纳米孔测序显示灵敏度显著提高（76.80%），阴性预测值（30.40%），巧合（77.92%），和诊断准确性（AUC=0.822）。结合Xpert检测实现了最高的诊断性能，灵敏度提高（81.20%），阳性预测值（98.20%），阴性预测值（35.00%），巧合(81.82%)，和AUC（0.843）。尽管抗酸染色有局限性，其与纳米孔测序的结合提高了筛查的有效性。
结论：与已建立的诊断方法如耐酸染色相比，分枝杆菌固体培养，XpertMTB/RIF,和DNA检测，第三代纳米孔测序技术显示,在糖尿病患者中检测疑似肺结核的敏感性显著提高.值得注意的是,纳米孔测序与Xpert检测的联合应用进一步提高了诊断准确性.
