Huang Hua-Rong, Fan Li-Chao, Rajbanshi Bhavana, Xu Jin-Fu
Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
PLoS One. 2015 May 14;10(5):e0127117. doi: 10.1371/journal.pone.0127117. eCollection 2015.
A new lateral flow immunoassay (LFA) for the detection of cryptococcal antigen was developed.
We aimed to systematically review all relevant studies to evaluate the diagnostic accuracy of the cryptococcal antigen LFA on serum, CSF and urine specimens.
We searched public databases including PubMed, Web of Science, Elsevier Science Direct and Cochrane Library for the English-language literature published up to September 2014. We conducted meta-analyses of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratios (DOR) and SROC of LFA in serum and CSF, respectively. The sensitivity of LFA in urine was also analyzed. Subgroup analyses were carried out to analyze the potential heterogeneity.
12 studies were included in this study. The pooled sensitivity and specificity values of LFA in serum were 97.6% (95% CI, 95.6% to 98.9%) and 98.1% (95% CI, 97.4% to 98.6%), respectively. The average PLR of LFA in serum was 43.787 (95% CI, 22.60-84.81) and the NLR was 0.03 (95% CI, 0.01-0.09). The pooled DOR was 2180.30 (95% CI, 868.92-5471.00) and the AUC was 0.9968. The pooled sensitivity and specificity values of LFA in CSF were 98.9% (95% CI, 97.9% to 99.5%) and 98.9% (95% CI, 98.0% to 99.5%), respectively. The average PLR of LFA in serum was 48.83 (95% CI, 21.59-110.40) and the NLR was 0.02 (95% CI, 0.01-0.04). The pooled DOR was 2931.10 (95% CI, 1149.20-7475.90) and the AUC was 0.9974. The pooled sensitivity value of LFA in urine was 85.0% (95% CI, 78.7% to 90.1%).
The study demonstrates a very high accuracy of LFA in serum and CSF for the diagnosis of cryptococcosis in patients at risk. LFA in urine can be a promising sample screening tool for early diagnosis of cryptococcosis.
开发了一种用于检测隐球菌抗原的新型侧向流动免疫分析法（LFA）。
我们旨在系统评价所有相关研究，以评估隐球菌抗原LFA对血清、脑脊液和尿液标本的诊断准确性。
我们检索了包括PubMed、科学网、爱思唯尔科学Direct和考科蓝图书馆在内的公共数据库，以获取截至2014年9月发表的英文文献。我们分别对LFA在血清和脑脊液中的敏感性、特异性、阳性似然比（PLR）、阴性似然比（NLR）、诊断比值比（DOR）和SROC进行了荟萃分析。还分析了LFA在尿液中的敏感性。进行亚组分析以分析潜在的异质性。
本研究纳入了12项研究。LFA在血清中的合并敏感性和特异性值分别为97.6%（95%CI，95.6%至98.9%）和98.1%（95%CI，97.4%至98.6%）。LFA在血清中的平均PLR为43.787（95%CI，22.60 - 84.81），NLR为0.03（95%CI，0.01 - 0.09）。合并DOR为2180.30（95%CI，868.92 - 5471.00），AUC为0.9968。LFA在脑脊液中的合并敏感性和特异性值分别为98.9%（95%CI，97.9%至99.5%）和98.9%（95%CI，98.0%至99.5%）。LFA在血清中的平均PLR为48.83（95%CI，21.59 - 110.40），NLR为0.02（95%CI，0.01 - 0.04）。合并DOR为2931.10（95%CI，1149.20 - 7475.90），AUC为0.9974。LFA在尿液中的合并敏感性值为85.0%（95%CI，78.7%至90.1%）。
该研究表明LFA在血清和脑脊液中对有风险患者隐球菌病的诊断具有非常高的准确性。尿液中的LFA可能是用于隐球菌病早期诊断的一种有前景的样本筛查工具。
