口腔拭子检测对肺结核诊断价值的Meta分析  

Meta-analysis of the diagnostic value of oral swab for pulmonary tuberculosis

作　　者：吴进凤 杨震[1] 张福真 姚丛[2] Wu Jinfeng;Yang Zhen;Zhang Fuzhen;Yao Cong(Changping Institute for Tuberculosis Control and Treatment,Beijing 102200,China;Department of Bacteriology and Immunology,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]北京市昌平区结核病防治所,北京102200 [2]首都医科大学附属北京胸科医院细菌免疫研究室,北京101149

出　　处：《中国防痨杂志》2024年第7期815-822,共8页Chinese Journal of Antituberculosis

基　　金：首都卫生发展科研专项项目(首发2024-1-1041)。

摘　　要：目的:系统评价口腔拭子检测对肺结核的诊断价值。方法:应用PubMed、Embase、Web of Science、Cochrane Library、中国知网、万方中国科技期刊数据库(Wanfang)、维普数据库(VIP)和中国生物医学文献数据库(CBM),检索建库至2024年4月12日发表的口腔拭子检测肺结核的相关文献,由2名研究者独立进行文献检索、筛选、数据提取和质量评价。采用STATA 16.0软件计算总体和亚组分析的集合敏感度、特异度、阳性似然比、阴性似然比和诊断优势比,利用Deek’s漏斗图评估发表偏倚。结果:共检索出173条文献记录,根据纳入标准和排除标准最终纳入15篇文献。Meta分析结果显示,口腔拭子对肺结核患者诊断的合并敏感度为65.0%(95%CI:54.0%~75.0%),合并特异度为96.0%(95%CI:92.0%~98.0%)。亚组分析显示,在成年肺结核患者中,口腔拭子的诊断敏感度和特异度分别为73.0%(95%CI:64.0%~80.0%)和95.0%(95%CI:83.0%~98.0%)。而舌拭子检测肺结核的敏感度为73.0%(95%CI:63.0%~80.0%),高于脸颊拭子(52.0%,95%CI:34.0%~70.0%)。结论:口腔拭子是诊断肺结核的一种很有前途的替代方法,并且在识别肺结核患者方面,舌拭子比脸颊拭子的敏感度更高。Objective:To systematically assess the diagnostic utility of oral swab testing in identifying pulmonary tuberculosis through a comprehensive meta-analysis.Methods:We conducted a detailed search of several databases including PubMed,Embase,Web of Science,Cochrane Library,CNKI,Wanfang,VIP,and CBM,to gather relevant studies published until April 12,2024,that investigate the use of oral swabs for detecting pulmonary tuberculosis.Literature search,screening,data extraction,and quality evaluation were independently executed by two researchers.We employed STATA 16.0 to compute the aggregated sensitivity,specificity,positive likelihood ratios,negative likelihood ratios,and diagnostic odds ratios for both overall and subgroup analyses.Publication bias was methodically evaluated using Deek’s funnel plot analysis.Results:We retrieved a total of 173 records,of which 15 studies met the predefined inclusion and exclusion criteria.Our meta-analysis revealed that the aggregate sensitivity of oral swabs for the diagnosis of pulmonary tuberculosis was 65.0%(95%CI:54.0%-75.0%),while the overall specificity reached 96.0%(95%CI:92.0%-98.0%).In subgroup analyses focusing on adult patients with pulmonary tuberculosis,oral swabs demonstrated a sensitivity of 73.0%(95%CI:64.0%-80.0%)and a specificity of 95.0%(95%CI:83.0%-98.0%).The sensitivity of tongue swabs in diagnosing pulmonary tuberculosis was 73.0%(95%CI:63.0%-80.0%),surpassing that of cheek swabs,which registered a sensitivity of 52.0%(95%CI:34.0%-70.0%).Conclusion:Oral swabs represent a viable alternative diagnostic tool for pulmonary tuberculosis.Notably,tongue swabs exhibit greater sensitivity compared to cheek swabs in detecting pulmonary tuberculosis cases.

关 键 词：结核 诊断 口腔 META分析 

分 类 号：R52[医药卫生—内科学] R540.4[医药卫生—临床医学]