Xpert结核分枝杆菌/利福平试验对结核病及耐多药结核病诊断价值的Meta分析  

The diagnostic value of Xpert MTB/RIF assay to tuberculosis and multi-drug resistant tuberculosis: a meta-analysis

作　　者：尹青琴[1] 焦伟伟[1] 孙琳[1] 肖婧[1] 吴喜蓉[1] 刘芳[1] 苗青[1] 徐放[1] 韩锐[1] 田建岭[1] 申阿东[1] 

机构地区：[1]首都医科大学附属北京儿童医院,北京市儿科研究所,儿科学国家重点学科,教育部儿科重大疾病研究重点实验室,北京100045

出　　处：《中国循证儿科杂志》2012年第5期341-348,共8页Chinese Journal of Evidence Based Pediatrics

基　　金：国家自然科学基金:30901632;北京市科委双十计划:Z111107055311042;北京市留学人员科技活动择优资助项目

摘　　要：目的评估Xpert结核分枝杆菌/利福平(MTB/RIF)试验对结核病的诊断价值。方法检索PubMed、Medline、中国知网、万方数据库等,收集Xpert MTB/RIF试验对结核病诊断价值的文献,检索起止时间均为建库至2012年6月。2名研究者独立进行资料提取和文献质量评估。采用Meta-Disc1.4软件进行Meta分析。结果共纳入26篇文献,其中2篇文献涉及儿童病例,包含了13270例来自临床患者的检测标本。Meta分析结果显示,Xpert MTB/RIF试验诊断结核病的汇总敏感度为87%(95%CI:86%～88%)、特异度为97%(95%CI:97%～97%)。按照结核病的类型和患者年龄进行亚组分析,Xpert MTB/RIF试验诊断肺结核的敏感度高于肺外结核病,90%(95%CI:89%～91%)vs76%(95%CI:72%～79%);诊断涂阴菌阳性和涂阳菌阳性结核病的敏感度分别为74%(95%CI:71%～76%)和99%(95%CI:98%～99%);对儿童肺结核的诊断敏感度比成人肺结核低,74%(95%CI:65%～83%)vs90%(95%CI:89%～92%)。Xpert MTB/RIF试验诊断耐多药结核病的敏感度为96%(95%CI:94%～97%),特异度为98%(95%CI:98%～99%)。结论 Xpert MTB/RIF试验诊断结核病的价值较高,尤其是成人结核病及耐多药结核病。Xpert MTB/RIF试验在儿童结核病中的诊断价值由于纳入文献较少,尚待进一步研究。Objective To evaluate the diagnostic value of Xpert MTB/RIF assay to tuberculosis systematically. Methods Studies about the diagnostic value of Xpert MTB/RIF assay to tuberculosis were searched in PubMed, Medline, CNKI and Wangfang database from establishment to June 2012. Two researchers fetched the data from included studies independently, and then Meta-Disc software（ version 1.4）was used for meta-analysis. Results A total of 26 studies were recruited in the analysis, including 13 270 sediments from clinical patients. In all kinds of tuberculosis, the pooled sensitivity and specificity of Xpert MTB/ RIF were 87% （95% CI：86% - 88% ） and 97% （95% CI：97% - 97% ） respectively. Then subgroup analysis was made by the types of tuberculosis and the patients＇ age, showing that Xpert MTB/RIF assay was more sensitive in diagnosing pulmonary tuberculosis than in extrapulmonary tuberculosis, and in smear-negative tuberculosis. The pooled sensitivity of Xpert MTB/RIF assay reached 74% （95% CI： 71% -76% ）, and the sensitivity in diagnosing pediatric tuberculosis was lower than adult tuberculosis. In multi-drug resistant tuberculosis, the pooled sensitivity and specificity were 96% （95% CI：94% -97% ）and 98% （95%CI：98% -99%）, respectively. Conclusions The diagnostic value of Xpert MTB/RIF assay to tuberculosis was very high, especially in adult tuberculosis. Because studies on pediatric tuberculosis were very few, the diagnostic value of Xpert MTB/RIF assay to pediatric tuberculosis should be confirmed by performing prospective cohort studies further.

关 键 词：Xpert结核分枝杆菌/利福平试验 结核病 诊断价值 META分析 

分 类 号：R52[医药卫生—内科学]