Nucleic acid amplification tests in the diagnosis of tuberculous pleuritis: a systematic review and meta-analysis
Nucleic acid amplification tests in the diagnosis of tuberculous pleuritis: a systematic review and meta-analysis
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DOI：
10.1186/1471-2334-4-6
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发表时间：
2004-02-23
影响因子：
3.7
通讯作者：
Colford, JM
中科院分区：
文献类型：
--
作者：
Pai, M;Flores, LL;Colford, JM
背景：结核性胸膜炎的常规检查有一些局限性。近年来，人们对核酸扩增试验（包括聚合酶链反应）等多种新型快速检测方法进行了评估。我们进行了一项系统综述，以确定核酸扩增（NAA）试验在诊断结核性胸膜炎中的准确性。方法：对38篇英文和西班牙文文章（含40项研究）进行系统综述和荟萃分析，通过检索6个电子数据库、手工检索选定的期刊、联系作者、专家和测试制造商进行鉴定。使用随机效应模型对敏感性、特异性和其他准确性进行汇总。摘要受试者工作特性曲线用于总结总体测试性能。使用亚组分析正式探讨了研究结果的异质性。结果：在纳入的40项研究中，26项使用内部（“家庭酿造”）测试，14项使用商业测试。商业检测总体敏感度低（0.62；95%可信区间[CI] 0.43, 0.77），特异性高（0.98；95%可信区间[CI] 0.96, 0.98）。商业试验的阳性和阴性似然比分别为25.4 （95% CI 16.2, 40.0）和0.40 （95% CI 0.24, 0.67）。所有商业测试都有一致的高特异性估计；然而，不同研究的敏感性估计值存在差异。在内部测试中，敏感性和特异性估计都存在显著的异质性。无法通过内部测试确定有临床意义的汇总估计。结论：我们的研究结果表明，商用NAA试验可能在确认（诊断）结核性胸膜炎方面具有潜在的作用。然而，这些测试具有低灵敏度和可变灵敏度，因此可能无法排除（排除）该疾病。因此，NAA测试结果不能取代常规测试；它们需要与临床发现和常规测试结果同时进行解释。由于研究结果的异质性，内部核酸扩增试验的准确性定义不清。内部NAA测试的临床适用性尚不清楚。
Background: Conventional tests for tuberculous pleuritis have several limitations. A variety of new, rapid tests such as nucleic acid amplification tests - including polymerase chain reaction - have been evaluated in recent times. We conducted a systematic review to determine the accuracy of nucleic acid amplification (NAA) tests in the diagnosis of tuberculous pleuritis.Methods: A systematic review and meta-analysis of 38 English and Spanish articles ( with 40 studies), identified via searches of six electronic databases, hand searching of selected journals, and contact with authors, experts, and test manufacturers. Sensitivity, specificity, and other measures of accuracy were pooled using random effects models. Summary receiver operating characteristic curves were used to summarize overall test performance. Heterogeneity in study results was formally explored using subgroup analyses.Results: Of the 40 studies included, 26 used in-house ("home-brew") tests, and 14 used commercial tests. Commercial tests had a low overall sensitivity (0.62; 95% confidence interval [CI] 0.43, 0.77), and high specificity (0.98; 95% CI 0.96, 0.98). The positive and negative likelihood ratios for commercial tests were 25.4 ( 95% CI 16.2, 40.0) and 0.40 ( 95% CI 0.24, 0.67), respectively. All commercial tests had consistently high specificity estimates; the sensitivity estimates, however, were heterogeneous across studies. With the in-house tests, both sensitivity and specificity estimates were significantly heterogeneous. Clinically meaningful summary estimates could not be determined for in-house tests.Conclusions: Our results suggest that commercial NAA tests may have a potential role in confirming ( ruling in) tuberculous pleuritis. However, these tests have low and variable sensitivity and, therefore, may not be useful in excluding ( ruling out) the disease. NAA test results, therefore, cannot replace conventional tests; they need to be interpreted in parallel with clinical findings and results of conventional tests. The accuracy of in-house nucleic acid amplification tests is poorly defined because of heterogeneity in study results. The clinical applicability of in-house NAA tests remains unclear.