GenoType MTBDRplus Assay for Rapid Detection of Multidrug Resistance in Mycobacterium tuberculosis: A Meta-Analysis
GenoType MTBDRplus Assay for Rapid Detection of Multidrug Resistance in Mycobacterium tuberculosis: A Meta-Analysis
复制标题
用于快速检测结核分枝杆菌多药耐药性的 GenoType MTBDRplus 测定：荟萃分析
DOI：
10.1371/journal.pone.0150321
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发表时间：
2016-03-02
期刊：
影响因子：
3.7
通讯作者：
Jin, Yan
中科院分区：
文献类型：
--
作者：
Bai, Yuanyuan;Wang, Yueling;Jin, Yan
背景快速、准确的药敏试验对耐多药结核病的检测具有迫切的需求。基因型MTBDRplus检测是一种很有前途的分子试剂盒，用于快速鉴定对一线抗结核药物异烟肼和利福平的耐药性。本荟萃分析的目的是评估基因型MTBDRplus在检测异烟肼和利福平耐药方面的诊断准确性，并与常规药敏试验进行比较。方法检索PubMed、EMBASE和Cochrane图书馆数据库，根据预先确定的标准确定研究。荟萃分析共纳入了40项研究。采用QUADAS-2软件和RevMan 5.2评估纳入研究的质量。采用STATA 13.0软件对试验的敏感性、特异性、阳性似然比、阴性似然比、诊断优势比、综合受试者工作特征曲线下面积进行分析。准确度测量的异质性采用Spearman相关系数和卡方检验。结果大多数研究均存在患者选择偏倚。对异烟肼、利福平和多药耐药的总敏感性(95%置信区间分别为0.91（0.88-0.94）、0.96（0.95-0.97）和0.91（0.86-0.94）。异烟肼、利福平和多药耐药的合并特异性（95% CI）分别为0.99（0.98 ~ 0.99）、0.98（0.97 ~ 0.99）和0.99（0.99 ~ 1.00）。总体受试者工作特征曲线下面积为0.99 ~ 1.00。结论基因型MTBDRplus对结核分枝杆菌异烟肼和/或利福平耐药的快速检测具有良好的准确性。在临床实践中，MTBDRplus方法可能是传统药敏试验的良好替代方法。
Background There is an urgent demand for rapid and accurate drug-susceptibility testing for the detection of multidrug-resistant tuberculosis. The GenoType MTBDRplus assay is a promising molecular kit designed for rapid identification of resistance to first-line anti-tuberculosis drugs, isoniazid and rifampicin. The aim of this meta-analysis was to evaluate the diagnostic accuracy of GenoType MTBDRplus in detecting drug resistance to isoniazid and rifampicin in comparison with the conventional drug susceptibility tests. Methods We searched PubMed, EMBASE, and Cochrane Library databases to identify studies according to predetermined criteria. A total of 40 studies were included in the meta-analysis. QUADAS-2 was used to assess the quality of included studies with RevMan 5.2. STATA 13.0 software was used to analyze the tests for sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the summary receiver operating characteristic curves. Heterogeneity in accuracy measures was tested with Spearman correlation coefficient and Chi-square. Results Patient selection bias was observed in most studies. The pooled sensitivity (95% confidence intervals were 0.91 (0.88–0.94) for isoniazid, 0.96 (0.95–0.97) for rifampicin, and 0.91(0.86–0.94) for multidrug-resistance. The pooled specificity (95% CI) was 0.99 (0.98–0.99) for isoniazid, 0.98 (0.97–0.99) for rifampicin and 0.99 (0.99–1.00) for multidrug-resistance, respectively. The area under the summary receiver operating characteristic curves ranged from 0.99 to 1.00. Conclusion This meta-analysis determined that GenoType MTBDRplus had good accuracy for rapid detection of drug resistance to isoniazid and/or rifampicin of M. tuberculosis. MTBDRplus method might be a good alternative to conventional drug susceptibility tests in clinical practice.