Sputum monitoring during tuberculosis treatment for predicting outcome: systematic review and meta-analysis.
Sputum monitoring during tuberculosis treatment for predicting outcome: systematic review and meta-analysis.
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DOI：
10.1016/s1473-3099(10)70071-2
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发表时间：
2010-06
影响因子：
56.3
通讯作者：
Steingart, Karen R.
中科院分区：
文献类型：
--
作者：
Horne, David J.;Royce, Sarah E.;Gooze, Lisa;Narita, Masahiro;Hopewell, Philip C.;Nahid, Payam;Steingart, Karen R.
对于新的肺结核（TB）患者，世界卫生组织先前建议在治疗的第二个月结束时进行痰涂片检查，如果阳性，则延长强化期。我们进行了一项系统回顾和荟萃分析，以评估治疗期间痰涂片或培养阳性预测肺结核失败或复发的准确性。我们检索了PubMed、EMBASE和科克伦图书馆，以查找截至2009年12月以英文发表的研究。我们纳入了随机对照试验、队列研究和病例对照研究，研究对象为在初始阶段接受过利福平标准化治疗方案的既往未经治疗的肺结核患者。在森林图中总结准确度结果，并使用分层回归方法合并。15篇论文符合纳入标准。2个月涂片（24%，95% CI 12-42，6项研究）和培养（40%，95% CI 25-56，4项研究）预测复发的合并灵敏度较低。相应的特异性（85%，95% CI 72-90）和（85%，95% CI 77-91）较高，但适中。对于失败，2个月涂片（7项研究）的敏感性较低（57%，95% CI 41-73），特异性较高（81%，95% CI 72-87），但中等。结核病治疗期间痰涂片镜检和分枝杆菌培养对预测失败和复发的敏感性低，特异性中等。虽然我们汇集了不同的患者组，但个体研究具有相似的性能特征。需要更好的预测标记。
In new pulmonary tuberculosis (TB) patients, the World Health Organization previously recommended performing sputum smear examination at the end of the second month of therapy and, if positive, to extend the intensive phase. We performed a systematic review and meta-analysis to evaluate the accuracy of a positive sputum smear or culture during treatment for predicting failure or relapse in pulmonary TB. We searched PubMed, EMBASE, and the Cochrane Library for studies published in English through December 2009. We included randomized controlled trials, cohort, and case-control studies of previously untreated pulmonary TB patients who had received a standardized regimen with rifampin in the initial phase. Accuracy results were summarized in forest plots and pooled using a hierarchical regression approach. Fifteen papers met inclusion criteria. The pooled sensitivities for both the 2 month smear (24%, 95% CI 12–42, 6 studies) and culture (40%, 95% CI 25–56, 4 studies) to predict relapse were low. Corresponding specificities (85%, 95% CI 72–90) and (85%, 95% CI 77–91) were higher, but modest. For failure, the 2 month smear (7 studies) had low sensitivity (57%, 95% CI 41–73) and higher, though modest, specificity (81%, 95% CI 72–87). Both sputum smear microscopy and mycobacterial culture during TB treatment have low sensitivity and modest specificity for predicting failure and relapse. Although we pooled a diverse group of patients, the individual studies had similar performance characteristics. Better predictive markers are needed.