GeneXpert MTB/RIF对骨关节结核诊断价值的Meta分析  

Meta-analysis on the diagnostic value of GeneXpert MTB/RIF for bone and joint tuberculosis

作　　者：南海[1] 张芸 杨新婷[2] 段鸿飞[2] NAN Hai;ZHANG Yun;YANG Xin-ting;DUAN Hong-fei(Department of Orthopaedics,HejiHospital,Changzhi Medical College,Changzhi 046000,China)

机构地区：[1]山西省长治医学院附属和济医院骨科,046000 [2]首都医科大学附属北京胸科医院北京市结核病胸部肿瘤研究所结核科

出　　处：《中国防痨杂志》2020年第9期973-980,共8页Chinese Journal of Antituberculosis

基　　金：北京市医院管理局“登峰”计划(DFL20151501,DFL20181601);北京市科学技术委员会重点项目(D181100000418003,Z191100006619078);北京市卫生和计划生育委员会北京市卫生与健康科技成果和适宜技术推广项目(2018-TG-43)。

摘　　要：目的系统评价GeneXpert MTB/RIF在骨关节结核诊断中的应用价值。方法应用计算机检索万方、维普、中国知网、PubMed、Embase、Cochrane Library等数据库,收集从建库至2020年5月发表的GeneXpert MTB/RIF诊断骨关节结核的相关文献,然后由2名研究者独立进行文献筛选、数据提取及质量评价。分别采用Reman 5.3和MetaDisc 1.4软件进行文献质量评价和Meta分析。结果共检索出350篇文献,依据纳入和排除标准,共筛选出来自4个国家的24篇文献,文献中共有3966例临床标本。Meta分析显示以临床综合诊断(CRS)为参考标准,GeneXpert MTB/RIF用于诊断骨关节结核的汇总敏感度和特异度分别为82.9%(95%CI:81.4%~84.3%)和86.3%(95%CI:84.3%~88.2%);以结核分枝杆菌培养和绝对浓度法药物敏感性试验(DST)为金标准,GeneXpert MTB/RIF诊断骨关节结核的汇总敏感度和特异度分别为93.9%(95%CI:92.2%~95.2%)和52.3%(95%CI:49.9%~54.6%)。GeneXpert MTB/RIF诊断利福平耐药骨关节结核也有很高的敏感度(89.5%,95%CI:87.5%~91.4%)和特异度(89.9%,95%CI:85.6%~93.2%)。结论 GeneXpert MTB/RIF对骨关节结核和利福平耐药骨关节结核有较高的诊断价值,可作为快速诊断骨关节结核的有效方法。Objective To systematically evaluate the diagnostic value of GeneXpert MTB/RIF assay for bone and joint tuberculosis. Methods Relevant literatures on the diagnosis of bone and joint tuberculosis by GeneXpert MTB/RIF assay were collected by searching Wanfang,VIP,China National Knowledge Infrastructure,PubMed,Embase,and Cochrane Library databases from establishment to May 2020,and then literature screening,data extraction and quality evaluation were performed independently by two researchers.Reman 5.3 and MetaDisc1.4 software were used for literature quality evaluation and Meta-analysis,respectively. Results A total of 350 literatures were retrieved,and 24 literatures from 4 countries were screened out according to the inclusion and exclusion criteria,including 3966 clinical specimens.Meta-analysis showed that compared to the comprehensive clinical diagnosis(CRS)as the reference standard,the pooled sensitivity and specificity of GeneXpert MTB/RIF assay for diagnosing the bone and joint tuberculosis were 82.9%(95%CI:81.4%-84.3%)and 86.3%(95%CI:84.3%-88.2%),respectively.Based on MTB culture and absolute concentration method drug sensitivity test(DST)as the gold standard,the pooled sensitivity and specificity were 93.9%(95%CI:92.2%-95.2%)and52.3%(95%CI:49.9%-54.6%),respectively.GeneXpert MTB/RIF assay also had high sensitivity(89.5%,95%CI:87.5%-91.4%)and specificity(89.9%,95%CI:85.6%-93.2%)in the diagnosis of rifampin(RIF)-resistant bone and joint tuberculosis. Conclusion GeneXpert MTB/RIF assay has a high diagnostic value for bone and joint tuberculosis and RIF-resistant bone and joint tuberculosis.It can be used as an effective method for the rapid diagnosis of bone and joint tuberculosis.

关 键 词：结核 骨关节 核酸扩增技术 核酸探针 诊断 Meta分析(主题) 

分 类 号：R529.2[医药卫生—内科学]