The Diagnostic Accuracy of Serologic and Molecular Methods for Detecting Visceral Leishmaniasis in HIV Infected Patients: Meta-Analysis
The Diagnostic Accuracy of Serologic and Molecular Methods for Detecting Visceral Leishmaniasis in HIV Infected Patients: Meta-Analysis
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DOI：
10.1371/journal.pntd.0001665
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发表时间：
2012-05-01
影响因子：
3.8
通讯作者：
Rabello, Ana
中科院分区：
文献类型：
--
作者：
Cota, Glaucia Fernandes;de Sousa, Marcos Roberto;Rabello, Ana
背景资料：人类内脏利什曼病（VL）是一种潜在的致命性疾病，已成为HIV感染患者的重要机会性疾病。在免疫功能低下的患者，血清学调查被认为是不是一个准确的诊断方法VL诊断和分子技术似乎特别prospered.Objective：这项工作是一个全面的系统评价和荟萃分析，以评估的准确性，血清学和分子检测VL的诊断，特别是在HIV感染patients.Methods：两个独立的审查员检索PubMed和LILACS数据库。采用QUADAS评分评价研究质量。将敏感性和特异性分别汇总，并与总体准确性指标进行比较：诊断比值比（DOR）和对称汇总受试者工作特征（sROC）。评价了以下试验：免疫荧光抗体试验（IFAT）、酶联免疫吸附试验（ELISA）、免疫印迹（Blot）、直接凝集试验（DAT）和全血和骨髓中的聚合酶链反应（PCR）。大多数研究都是在欧洲进行的。血清学试验在性能上差异很大，但总体灵敏度有限。IFAT的敏感性较差，范围为11%至82%。DAT 36.01（9.95-130.29）和Blot 27.51（9.27-81.66）的DOR（95%置信区间）高于IFAT 7.43（3.08-1791）和ELISA 3.06（0.71-13.10）。全血PCR的DOR最高，为400.35（58.47-2741.42）。结论：主要基于查氏利什曼原虫感染的证据，血清学检测不应排除HIV感染者中VL的诊断，但结合临床病例定义，即使低滴度的阳性检测也具有诊断价值。考虑到现有的证据，基于DNA检测的测试是高度敏感的，可能有助于诊断性检查。
Background: Human visceral leishmaniasis (VL), a potentially fatal disease, has emerged as an important opportunistic condition in HIV infected patients. In immunocompromised patients, serological investigation is considered not an accurate diagnostic method for VL diagnosis and molecular techniques seem especially promising.Objective: This work is a comprehensive systematic review and meta-analysis to evaluate the accuracy of serologic and molecular tests for VL diagnosis specifically in HIV-infected patients.Methods: Two independent reviewers searched PubMed and LILACS databases. The quality of studies was assessed by QUADAS score. Sensitivity and specificity were pooled separately and compared with overall accuracy measures: diagnostic odds ratio (DOR) and symmetric summary receiver operating characteristic (sROC).Results: Thirty three studies recruiting 1,489 patients were included. The following tests were evaluated: Immunofluorescence Antibody Test (IFAT), Enzyme linked immunosorbent assay (ELISA), immunoblotting (Blot), direct agglutination test (DAT) and polimerase chain reaction (PCR) in whole blood and bone marrow. Most studies were carried out in Europe. Serological tests varied widely in performance, but with overall limited sensitivity. IFAT had poor sensitivity ranging from 11% to 82%. DOR (95% confidence interval) was higher for DAT 36.01 (9.95-130.29) and Blot 27.51 (9.27-81.66) than for IFAT 7.43 (3.08-1791) and ELISA 3.06 (0.71-13.10). PCR in whole blood had the highest DOR: 400.35 (58.47-2741.42). The accuracy of PCR based on Q-point was 0.95; 95%CI 0.92-0.97, which means good overall performance.Conclusion: Based mainly on evidence gained by infection with Leishmania infantum chagasi, serological tests should not be used to rule out a diagnosis of VL among the HIV-infected, but a positive test at even low titers has diagnostic value when combined with the clinical case definition. Considering the available evidence, tests based on DNA detection are highly sensitive and may contribute to a diagnostic workup.