Performance of Saliva, Oropharyngeal Swabs, and Nasal Swabs for SARS-CoV-2 Molecular Detection: a Systematic Review and Meta-analysis.
Performance of Saliva, Oropharyngeal Swabs, and Nasal Swabs for SARS-CoV-2 Molecular Detection: a Systematic Review and Meta-analysis.
复制标题
DOI：
10.1128/jcm.02881-20
复制
发表时间：
2021-04-20
影响因子：
9.4
通讯作者：
Denkinger CM
中科院分区：
文献类型：
--
作者：
Lee RA;Herigon JC;Benedetti A;Pollock NR;Denkinger CM
鼻咽拭子被认为是呼吸道病毒（包括SARS-CoV-2）诊断检测中产量最高的样本。需要在各种环境中提高SARS-CoV-2检测能力，再加上样品采集用品的短缺，促使人们寻找具有高灵敏度的替代样品类型。鼻咽拭子被认为是呼吸道病毒（包括SARS-CoV-2）诊断检测中产量最高的样本。需要在各种环境中提高SARS-CoV-2检测能力，再加上样品采集用品的短缺，促使人们寻找具有高灵敏度的替代样品类型。我们系统地回顾了文献，以了解与NP拭子相比，其他样本类型的性能。我们系统地检索了PubMed、谷歌Scholar、medRxiv和bioRxiv（最后检索日期为2020年10月1日），以比较使用核酸扩增检测（NAAT）诊断SARS-CoV-2的其他标本类型（唾液、口咽[OP]和鼻[NS]拭子）与NP拭子的比较研究。进行逻辑正态随机效应荟萃分析，计算总体和亚组中阳性替代标本百分比、阳性NP百分比和双阳性百分比。使用QUADAS 2工具评估偏倚。从1253个独特的引用中，我们确定了25个唾液研究、11个NS研究、6个OP研究和4个OP/NS研究符合纳入标准。三种标本类型的阳性率（NS [82%， 95% CI: 73至90%]，OP [84%， 95% CI: 57至100%]和唾液[88%，95% CI: 81至93%]）低于NP棉子，而OP/NS相结合的NP表现（97%，95% CI: 90至100%）。没有RNA提取（唾液）和使用更敏感的NAAT （NS）大大降低了阳性样品的替代样品收率。NP拭子仍然是诊断SARS-CoV-2的金标准，尽管替代标本很有希望。关于标本采集、处理方案和人群（儿童与成人、疾病病程晚期与早期）变化的影响，仍有许多未知因素，因此迫切需要对采样策略进行面对面的研究。
Nasopharyngeal (NP) swabs are considered the highest-yield sample for diagnostic testing for respiratory viruses, including SARS-CoV-2. The need to increase capacity for SARS-CoV-2 testing in a variety of settings, combined with shortages of sample collection supplies, have motivated a search for alternative sample types with high sensitivity. Nasopharyngeal (NP) swabs are considered the highest-yield sample for diagnostic testing for respiratory viruses, including SARS-CoV-2. The need to increase capacity for SARS-CoV-2 testing in a variety of settings, combined with shortages of sample collection supplies, have motivated a search for alternative sample types with high sensitivity. We systematically reviewed the literature to understand the performance of alternative sample types compared to NP swabs. We systematically searched PubMed, Google Scholar, medRxiv, and bioRxiv (last retrieval 1 October 2020) for comparative studies of alternative specimen types (saliva, oropharyngeal [OP], and nasal [NS] swabs) versus NP swabs for SARS-CoV-2 diagnosis using nucleic acid amplification testing (NAAT). A logistic-normal random-effects meta-analysis was performed to calculate % positive alternative-specimen, % positive NP, and % dual positives overall and in subgroups. The QUADAS 2 tool was used to assess bias. From 1,253 unique citations, we identified 25 saliva, 11 NS, 6 OP, and 4 OP/NS studies meeting inclusion criteria. Three specimen types captured lower % positives (NS [82%, 95% CI: 73 to 90%], OP [84%, 95% CI: 57 to 100%], and saliva [88%, 95% CI: 81 to 93%]) than NP swabs, while combined OP/NS matched NP performance (97%, 95% CI: 90 to 100%). Absence of RNA extraction (saliva) and utilization of a more sensitive NAAT (NS) substantially decreased alternative-specimen yield of positive samples. NP swabs remain the gold standard for diagnosis of SARS-CoV-2, although alternative specimens are promising. Much remains unknown about the impact of variations in specimen collection, processing protocols, and population (pediatric versus adult, late versus early in disease course), such that head-to head studies of sampling strategies are urgently needed.