Su Guoming, Fu Zhuqing, Hu Liren, Wang Yueying, Zhao Zuguo, Yang Weiqing
Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical College, Dongguan, China.
Department of Microbiology and Immunology, Guangdong Medical College, Zhanjiang, China.
PLoS One. 2015 May 21;10(5):e0127195. doi: 10.1371/journal.pone.0127195. eCollection 2015.
We aim to evaluate the accuracy of the 16S ribosomal ribonucleic acid (rRNA) gene polymerase chain reaction (PCR) test in the diagnosis of bloodstream infections through a systematic review and meta-analysis.
A computerized literature search was conducted to identify studies that assessed the diagnostic value of 16S rRNA gene PCR test for bloodstream infections. Study quality was assessed using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. We calculated the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and their 95% confidence intervals (95% CI) for each study. Summary receiver operating characteristic (SROC) curve was used to summarize overall test performance. Statistical analysis was performed in Meta-DiSc 1.4 and Stata/SE 12.0 software.
Twenty-eight studies were included in our meta-analysis. Using random-effect model analysis, the pooled sensitivity, specificity, PLR, NLR, and DOR were 0.87 (95% CI, 0.85-0.89), 0.94 (95% CI, 0.93-0.95), 12.65 (95% CI, 8.04-19.90), 0.14 (95% CI, 0.08-0.24), and 116.76 (95% CI, 52.02-262.05), respectively. The SROC curve indicated that the area under the curve (AUC) was 0.9690 and the maximum joint sensitivity and specificity (Q*) was 0.9183. In addition, heterogeneity was statistically significant but was not caused by the threshold effect.
Existing data suggest that 16S rRNA gene PCR test is a practical tool for the rapid screening of sepsis. Further prospective studies are needed to assess the diagnostic value of PCR amplification and DNA microarray hybridization of 16S rRNA gene in the future.
我们旨在通过系统评价和荟萃分析来评估16S核糖体核糖核酸（rRNA）基因聚合酶链反应（PCR）检测在血流感染诊断中的准确性。
进行计算机文献检索，以识别评估16S rRNA基因PCR检测对血流感染诊断价值的研究。使用修订后的诊断准确性研究质量评估（QUADAS-2）工具评估研究质量。我们计算了每项研究的敏感性、特异性、阳性似然比（PLR）、阴性似然比（NLR）、诊断比值比（DOR）及其95%置信区间（95%CI）。使用汇总受试者工作特征（SROC）曲线来总结总体检测性能。在Meta-DiSc 1.4和Stata/SE 12.0软件中进行统计分析。
我们的荟萃分析纳入了28项研究。采用随机效应模型分析，合并敏感性、特异性、PLR、NLR和DOR分别为0.87（95%CI，0.85-0.89）、0.94（95%CI，0.93-0.95）、12.65（95%CI，8.04-19.90）、0.14（95%CI，0.08-0.24）和116.76（95%CI，52.02-262.05）。SROC曲线表明曲线下面积（AUC）为0.9690，最大联合敏感性和特异性（Q*）为0.9183。此外，异质性具有统计学意义，但不是由阈值效应引起的。
现有数据表明16S rRNA基因PCR检测是快速筛查败血症的实用工具。未来需要进一步的前瞻性研究来评估16S rRNA基因的PCR扩增和DNA微阵列杂交的诊断价值。
