In-house nucleic acid amplification tests for the detection of Mycobacterium tuberculosis in sputum specimens: meta-analysis and meta-regression.
In-house nucleic acid amplification tests for the detection of Mycobacterium tuberculosis in sputum specimens: meta-analysis and meta-regression.
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DOI：
10.1186/1471-2180-5-55
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发表时间：
2005-10-03
期刊：
影响因子：
4.2
通讯作者：
Riley LW
中科院分区：
文献类型：
--
作者：
Flores LL;Pai M;Colford JM Jr;Riley LW
自该技术首次引入以来，世界文献中已有200多项与核酸扩增（NAA）试验直接从临床标本中检测结核分枝杆菌相关的研究。NAA测试可以作为商业试剂盒或由报告调查人员自己设计的测试（内部测试）。内部测试的准确性差异很大，导致测试准确性异质性的因素没有得到很好的表征。在这里，我们使用荟萃分析方法，包括荟萃回归，以确定与影响测试准确度的研究设计和测定方案相关的因素，以确定与准确度高估计值相关的因素。通过搜索多个数据库和来源，我们确定了2520个潜在的相关引文，并分析了来自65个出版物的84个独立的研究，这些出版物涉及内部NAA测试以检测M。痰液样本中的结核病。通过亚组和荟萃回归分析确定检验准确性估计值的异质性来源。在分析的84项研究中，敏感性和特异性估计值差异很大;敏感性从9.4%到100%不等，特异性估计值从5.6%到100%不等。在荟萃回归分析中，使用IS 6110作为靶标，以及使用巢式PCR方法似乎与较高的诊断准确性显著相关。结核病的内部NAA测试的准确性估计是高度异质性的。使用IS 6110作为扩增靶点和使用巢式PCR方法似乎与更高的诊断准确性相关。然而，内部NAA测试的敏感性和特异性的实质性异质性使得难以对测试准确性进行临床有用的估计。基于NAA的检测M.痰标本中的结核病应考虑到这些结果，以提高准确性的内部NAA测试。
More than 200 studies related to nucleic acid amplification (NAA) tests to detect Mycobacterium tuberculosis directly from clinical specimens have appeared in the world literature since this technology was first introduced. NAA tests come as either commercial kits or as tests designed by the reporting investigators themselves (in-house tests). In-house tests vary widely in their accuracy, and factors that contribute to heterogeneity in test accuracy are not well characterized. Here, we used meta-analytical methods, including meta-regression, to identify factors related to study design and assay protocols that affect test accuracy in order to identify those factors associated with high estimates of accuracy. By searching multiple databases and sources, we identified 2520 potentially relevant citations, and analyzed 84 separate studies from 65 publications that dealt with in-house NAA tests to detect M. tuberculosis in sputum samples. Sources of heterogeneity in test accuracy estimates were determined by subgroup and meta-regression analyses. Among 84 studies analyzed, the sensitivity and specificity estimates varied widely; sensitivity varied from 9.4% to 100%, and specificity estimates ranged from 5.6% to 100%. In the meta-regression analysis, the use of IS6110 as a target, and the use of nested PCR methods appeared to be significantly associated with higher diagnostic accuracy. Estimates of accuracy of in-house NAA tests for tuberculosis are highly heterogeneous. The use of IS6110 as an amplification target, and the use of nested PCR methods appeared to be associated with higher diagnostic accuracy. However, the substantial heterogeneity in both sensitivity and specificity of the in-house NAA tests rendered clinically useful estimates of test accuracy difficult. Future development of NAA-based tests to detect M. tuberculosis from sputum specimens should take into consideration these findings in improving accuracy of in-house NAA tests.
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影响因子：
9.4
作者：
Down, JA;OConnell, MA;Cole, G
通讯作者：
Cole, G
DOI：
10.1016/0962-8479(95)90533-2
发表时间：
1995-12-01
期刊：
TUBERCLE AND LUNG DISEASE
影响因子：
--
作者：
Das, S;Paramasivan, CN;Narayanan, PR
通讯作者：
Narayanan, PR
影响因子：
7.2
作者：
Glas, AS;Lijmer, JG;Bossuyt, PMM
通讯作者：
Bossuyt, PMM
影响因子：
9.4
作者：
FORBES, BA;HICKS, KES
通讯作者：
HICKS, KES
影响因子：
9.4
作者：
AMICOSANTE, M;RICHELDI, L;SALTINI, C
通讯作者：
SALTINI, C