Diagnostic accuracy of Xpert MTB/RIF for tuberculous meningitis: systematic review and meta-analysis.
Diagnostic accuracy of Xpert MTB/RIF for tuberculous meningitis: systematic review and meta-analysis.
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专家MTB/RIF诊断结核性脑膜炎的准确性：系统评价和荟萃分析。
DOI：
10.1111/tmi.13525
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Vidal JE
中科院分区：
文献类型：
--
作者：
Hernandez AV;de Laurentis L;Souza I;Pessanha M;Thota P;Roman YM;Barboza-Meca J;Boulware DR;Vidal JE
本系统回顾评价了Xpert MTB/RIF诊断结核性脑膜炎(TBM)的准确性。到2019年3月，对PubMed和其他五个数据库进行了系统搜索。所有评估Xpert MTB/RIF对脑脊液(CSF)样本诊断准确性的研究均包括在内。参考标准是确定的或确定的加上可能的TBM。通过QUADAS-2工具对研究质量进行评估。我们进行双变量随机效应荟萃分析，并计算汇总诊断统计量。我们确定了30项研究(n=3972名参与者)，包括5项队列研究和25项横断面研究。参考标准为确定的TB(n=28项研究)或确定加可能的TBM(n=6项研究)。合并Xpert MTB/RIF对确诊TBM的敏感性为85%(95%CI，70~93%)，特异性为98%(95%CI，97~99%)，阴性似然比为0.15(95%CI，0.04~0.27)。对于可能的TBM病例，合并敏感度为81%(95%CI，66-90%)，特异度为99%(95%CI，97-99%)。对于两种参考标准类型，Meta分析显示曲线下的C型统计区域为0.98。QUADAS-2工具显示存在偏见的风险较低，对适用性的担忧也较低。研究方法的异质性很高。Xpert MTB/RIF对TBM的诊断具有较高的准确性，但Xpert MTB/RIF试验阴性不能排除TBM。可能需要重复XPERT测试。在临床实践中，与传统的TBM诊断方法或以前的商业核酸扩增技术相比，Xpert MTB/RIF提高了速度和灵敏度。
This systematic review evaluated the diagnostic accuracy of Xpert MTB/RIF to detect tuberculous meningitis (TBM). The PubMed and five other databases were systematically searched through March 2019. All studies evaluating diagnostic accuracy of Xpert MTB/RIF on cerebrospinal fluid (CSF) samples were included. Reference standards were definitive or definite plus probable TBM. The quality of studies was assessed by the QUADAS-2 tool. We performed bivariate random effects meta-analysis, and calculated summary diagnostic statistics. We identified 30 studies (n=3972 participants), including 5 cohort studies and 25 cross-sectional studies. Reference standards were definite TB (n=28 studies) or definite plus probable TBM (n=6 studies). The pooled Xpert MTB/RIF sensitivity was 85% (95%CI, 70–93%) and specificity was 98% (95%CI, 97–99%) with negative likelihood ratio of 0.15 (95%CI, 0.04–0.27) for definite TBM. For probable TBM cases, pooled sensitivity was 81% (95%CI, 66–90%), and specificity was 99% (95%CI, 97–99%). For both reference standard types, meta-analyses showed a C-stastic area under the curve of 0.98. The QUADAS-2 tool revealed low risk of bias as well as low concerns regarding applicability. Methodological heterogeneity was high among studies. Xpert MTB/RIF showed high accuracy for TBM diagnosis, but a negative Xpert MTB/RIF test does not rule out TBM. Repeat Xpert testing may be necessary. In clinical practice, Xpert MTB/RIF adds speed and sensitivity when compared to classic TBM diagnostic methods or previous commercial nucleic acid amplification techniques.
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影响因子：
2
作者：
Das, Arghya;Anupurba, Shampa;Tripathi, Rajneesh
通讯作者：
Tripathi, Rajneesh
影响因子：
3.7
作者：
Britz E;Perovic O;von Mollendorf C;von Gottberg A;Iyaloo S;Quan V;Chetty V;Sriruttan C;Ismail NA;Nanoo A;Musekiwa A;Reddy C;Viljoen K;Cohen C;Govender NP
通讯作者：
Govender NP
DOI：
10.5588/ijtld.15.0253
发表时间：
2015-10
期刊：
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
影响因子：
--
作者：
Bahr NC;Tugume L;Rajasingham R;Kiggundu R;Williams DA;Morawski B;Alland D;Meya DB;Rhein J;Boulware DR
通讯作者：
Boulware DR
影响因子：
4
作者：
Freeman, Suzanne C.;Kerby, Clareece R.;Sutton, Alex J.
通讯作者：
Sutton, Alex J.
影响因子：
3.7
作者：
Jarvis JN;Meintjes G;Williams A;Brown Y;Crede T;Harrison TS
通讯作者：
Harrison TS