GeneXpert MTB/RIF对结核性脑膜炎诊断价值的Meta分析  

Meta-analysis of GeneXpert MTB/RIF in the diagnosis of tuberculous meningitis

作　　者：庞宇 张芸 梁清涛[2] 杨新婷[2] 段鸿飞[2] Pang Yu;Zhang Yun;Liang Qingtao;Yang Xinting;Duan Hongfei(Department of Science and Technology,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China;Department of Tuberculosis,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]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科技处,101149 [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,101149

出　　处：《神经疾病与精神卫生》2022年第6期420-427,共8页Journal of Neuroscience and Mental Health

基　　金：北京市临床重点专科项目;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在结核性脑膜炎诊断中的应用价值。方法通过计算机检索PubMed、Ovid、Embase、Scopus、Web of Science、Cochrane Library及中国知网、维普数据库、万方数据库等国内外数据库,收集建库至2021年11月发表的与GeneXpert MTB/RIF诊断结核性脑膜炎相关的中英文文献。应用RevMan 5.3和Meta-Disc 1.4软件进行文献质量评价和Meta分析,计算汇总敏感度、特异度、阳性似然比(PLR)、阴性似然比(NLR)、诊断比值比(DOR),绘制汇总受试者工作特征(SROC)曲线并计算曲线下面积(AUC)。结果共纳入28篇文献,共包含5137例临床标本。Meta分析显示,GeneXpert MTB/RIF用于诊断结核性脑膜炎的汇总敏感度为0.412(95%CI:0.392~0.431),特异度为0.967(95%CI:0.961~0.973)。以临床综合诊断标准为诊断标准,GeneXpert MTB/RIF用于诊断结核性脑膜炎的汇总敏感度和特异度分别为0.362(95%CI:0.340~0.384)、0.973(95%CI:0.964~0.980);以结核分枝杆菌培养为标准,GeneXpert MTB/RIF诊断结核性脑膜炎的汇总敏感度和特异度分别为0.589(95%CI:0.547~0.630)和0.961(95%CI:0.950~0.970)。脑脊液离心处理后,GeneXpert MTB/RIF诊断结核性脑膜炎的汇总敏感度和特异度分别为0.431(95%CI:0.405~0.456)、0.966(95%CI:0.957~0.973)。HIV感染情况下,GeneXpert MTB/RIF诊断结核性脑膜炎的汇总敏感度为0.405(95%CI:0.375~0.434),特异度为0.967(95%CI:0.956~0.976)。结论脑脊液经离心处理后,GeneXpert MTB/RIF检测对结核性脑膜炎有较高的诊断价值,可作为快速诊断结核性脑膜炎的有效方法。Objective To systematically investigate the diagnostic value of GeneXpert MTB/RIF essays in cerebrospinal fluid for tuberculous meningitis.Methods Relevant Chinese and English publications from the establishment of the database up to November 2021 about the diagnostic accuracy of GeneXpert MTB/RIF essays to tuberculous meningitis were searched in Pubmed,OVid,Embase,Scopus,Web of Science,Cochrane Library,CNKI,VIP and Wanfang databases.Then RevMan 5.3 and Meta-Disc 1.4 software were used to assess the quality of studies and conduct statistical analysis respectively.Sensitivity,specificity,positive likelihood ratio(PLR),negative likelihood ratio(NLR)and diagnostic odds of radio(DOR)were pooled.Summary receiver operating characteristic(SROC)curves and area under the curve(AUC)were calculated.Results A total of 28 articles were recruited,including 5137 specimens from clinical patients.Meta-analysis showed that the pooled sensitivity and specificity of GeneXpert MTB/RIF essays for diagnosing tuberculous meningitis is 0.412(95%CI:0.392-0.431)and 0.967(95%CI:0.961-0.973)respectively.When using composite neference standard as the diagnostic standard,the pooled sensitivity and specificity is 0.362(95%CI:0.340-0.384)and 0.973(95%CI:0.964-0.980).When using the culture of mycobacterium tuberculosis as the standard,the pooled sensitivity and specificity is 0.589(95%CI:0.547-0.630)and 0.961(95%CI:0.950-0.970).After centrifugation of cerebrospinal fluid,the pooled sensitivity and specificity is 0.431(95%CI:0.405-0.456)and 0.966(95%CI:0.957-0.973).In the case of HIV infection,the pooled sensitivity and specificity is 0.405(95%CI:0.375-0.434)and 0.967(95%CI:0.956-0.976).Conclusions GeneXpert MTB/RIF essays plays a valuable value in the diagnosis of tuberculous meningitis if the cerebrospinal fluid is centrifuged.It is recommended to diagnose tuberculous meningitis by using GeneXpert MTB/RIF essays in cerebrospinal fluid.

关 键 词：结核 脑膜炎 GeneXpert MTB/RIF 诊断 META分析 

分 类 号：R529.3[医药卫生—内科学]