摘要
目的:通过Meta分析比较宏基因组二代测序技术(metagenomic next-generation sequencing,mNGS)和GeneXpert MTB/RIF(简称“Xpert”)对结核病的诊断效能。方法:系统检索PubMed、Embase、Cochrane Library、Web of Science、中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方和维普数据库自建库至2022年7月5日公开发表的关于mNGS与Xpert对结核病诊断准确性的文献。根据预先制定的纳入与排除标准,由2名研究者独立进行文献筛选、数据提取、偏倚风险和适用性评价,并对两种技术的诊断效能进行统计分析。结果:最终纳入12篇文献共1344例患者资料。Meta分析结果显示,mNGS诊断结核病的合并敏感度、合并特异度、合并诊断比值比及AUC值分别为63.4%、99.8%、58.6和0.931,Xpert分别为50.3%、99.9%、23.8和0.860,两者并联诊断(mNGS+Xpert)分别为68.7%、99.8%、91.2和0.978。同时,mNGS对脑脊液组及其他肺外或多部位标本组的检测敏感度分别为64.6%和60.8%,Xpert分别为41.8%和50.8%。结论:mNGS和Xpert均具有结核病诊断应用价值,且mNGS和mNGS联合Xpert检测的总敏感度均高于Xpert,但三者特异度无差异。联合应用mNGS检测有望提高Xpert阴性但临床仍怀疑结核感染的病原检出率,尤其是肺外结核。
Objective:To compare the diagnostic efficacy of metagenomic next-generation sequencing(mNGS)and GeneXpert MTB/RIF(Xpert)for tuberculosis using meta-analysis.Methods:Literatures about the diagnostic accuracy of mNGS and Xpert for tuberculosis were systematically searched in PubMed,Embase,Cochrane Library,Web of Science,China National Knowledge Infrastructure(CNKI),China Biomedical Literature Database(CBM),Wanfang and VIP databases from the establishment to July 5,2022.According to the inclusion and exclusion criteria,two reviewers independently conducted the screening and inclusion of literatures,data extraction,risk of bias evaluation,as well as analysis for the diagnostic performance of mNGS and Xpert.Results:Twelve literatures with a total of 1344 samples were ultimately included.As the meta-analysis showed,the pooled sensitivity,specificity,diagnostic odds ratio and AUC of mNGS in tuberculosis diagnosis were 63.4%,99.8%,58.6 and 0.931,respectively,which of Xpert were 50.3%,99.9%,23.8 and 0.860,respectively,while those of the parallel diagnosis of mNGS and Xpert were 68.7%,99.8%,91.2 and 0.978,respectively.Meanwhile,the sensitivities of mNGS on cerebrospinal fluid and other extra-pulmonary or multi-site specimens were 64.6%and 60.8%,respectively,and those of Xpert were 41.8%and 50.8%,respectively.Conclusion:Both mNGS and Xpert performed well in the diagnosis of tuberculosis.The sensitivities of mNGS single detection and detection combined with Xpert were higher than that of Xpert single detection,but there is no difference in the specificities.The combined detection with mNGS is expected to improve the detection rate of Xpert negative but clinically suspected tuberculosis infection,especially the pathogen of extrapulmonary tuberculosis.
作者
王雅娟
曹新益
刘升明
Wang Yajuan;Cao Xinyi;Liu Shengming(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Ji’nan University,Guangzhou 510630,China)
出处
《中国防痨杂志》
CAS
CSCD
2022年第12期1327-1337,共11页
Chinese Journal of Antituberculosis
关键词
结核
宏基因组二代测序
分子诊断技术
对比研究
META分析
Tuberculosis
Metagenomic next-generation sequencing
Molecular diagnostic techniques
Comparative study
Meta-analysis
