宏基因组二代测序技术在肺结核诊断中应用价值的meta分析  

Meta-analysis of the application value of metagenomic next-generation sequencing technology in the diagnosis of pulmonary tuberculosis

作　　者：沃拉孜汗·玛德尼亚提 迪力夏提·图尔迪麦麦提 李梦晨 拜合提尼沙·吐尔地[1] Wolazihan Madeniyati;Dilixiati Tuerdimaimaiti;Li Mengchen;Baihetinisha Tuerdi(Respiratory Intensive Care Unit,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China)

机构地区：[1]新疆医科大学第一附属医院呼吸重症监护室,新疆乌鲁木齐830000

出　　处：《临床荟萃》2023年第5期389-398,共10页Clinical Focus

基　　金：省部共建国家重点实验室中亚高发病成因与防治国家重点实验室开放课题——Tim-1通过PI3K-Akt-mTOR信号通路调节肺结核病患者T淋巴细胞免疫应答的作用机制研究(SKL-HIDCA-2022-18)。

摘　　要：目的评价宏基因组二代测序(metagenomic next-generation sequencing,mNGS)应用于不同的临床标本对于肺结核(pulmonary tuberculosis,PTB)的诊断价值。方法计算机检索PubMed、Embase、The Cochrane Library、知网(CNKI)、万方和维普等数据库中于建库至2022年11月公开发表的宏基因组二代测序技术诊断PTB的相关研究,获得的文献经过严格筛选和质量评估,由2名研究人员独立筛选文献,提取数据,并评估纳入研究偏倚风险之后,采用StataSE16软件和Revman5.3软件进行meta分析。结果纳入符合标准的文献11篇,共计1995例,meta分析结果显示,mNGS检测肺标本诊断PTB的敏感度为70%(95%CI:58%~79%),特异度为99%(95%CI:98%~100%)、阳性似然比(PLR)为106.9(95%CI:31.1~366.6)、阴性似然比(NLR)为0.31(95%CI:0.21~0.43)、诊断比值比(DOR)为350(95%CI:81~1512)、曲线下面积(AUC)为0.97;mNGS检测支气管肺泡灌洗液(broncho alveolar lavage fluid,BALF)诊断PTB敏感度为71%(95%CI:55%~83%),特异度为99%(95%CI:97%~100%),PLR为76.4(95%CI:26.6~218.9),NLR为0.30(95%CI:0.18~0.48),DOR为258(95%CI:75~895)、AUC为0.99;mNGS检测肺组织诊断PTB敏感度为81%(95%CI:69%~89%),特异度为97%(95%CI:88%~99%),PLR为26.0(95%CI:6.6~102.4),NLR为0.19(95%CI:0.11~0.33),DOR为135(95%CI:29~639)、AUC为0.97。结论mNGS诊断PTB具有较高的应用价值,尤其在痰菌阴性PTB的诊断价值更突出,可作为一种快速诊断PTB的辅助工具。Objective To evaluate the diagnostic value of metagenomic next-generation sequencing(mNGS)technology in different clinical specimens for pulmonary tuberculosis(PTB).Methods Relevant researches on the diagnosis of PTB by using mNGS included in PubMed,Embase,The Cochrane Library,CNKI,Wanfang and Vip and other databases for published from the establishment to November 2022were searched.After strict screening and quality evaluation,the literatures were screened by two researchers independently,followed by data extraction and risk assessment of inclusion study bias.StataSE16 software and Revman5.3 software were used for meta-analysis.Results A total of 11 eligible literature and 1995 patients were included in the meta-analysis.The results showed that the sensitivity and specificity of mNGS for PTB diagnosis in lung specimens was 70%(95%CI:58%-79%)and 99%(95%CI:98%-100%),positive likelihood ratio(PLR)was 106.9(95%CI:31.1-366.6),negative likelihood ratio(NLR)was 0.31(95%CI:0.21-0.43),diagnostic odds ratio(DOR)was 350(95%CI:81-1512)and the area under curve(AUC)was 0.97.The sensitivity,specificity,PLR,NLR,DOR,and AUC of mNGS for PTB diagnosis in bronchoalveolar lavage fluid(BALF)were 71%(95%CI:55%-83%),99%(95%CI:97%-100%),76.4(95%CI:26.6-218.9),0.30(95%CI:0.18-0.48),258(95%CI:75-895),and 0.99,respectively.The sensitivity and specificity of mNGS for PTB diagnosis in lung tissues were 81%(95%CI:69%-89%)and 97%(95%CI:88%-99%),PLR was 26.0(95%CI:6.6-102.4),NLR was 0.19(95%CI:0.11-0.33),DOR was 135(95%CI:29-639),and AUC was 0.97.Conclusion Application of mNGS technology exerts high diagnostic value for PTB,especially for sputum-negative PTB,which can be used as an auxiliary tool for rapid diagnosis of PTB.

关 键 词：结核 肺 宏基因组二代测序 诊断价值 META分析 

分 类 号：R521[医药卫生—内科学]