Zhejiang Tuberculosis Diagnosis and Treatment Center, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, Zhejiang, China.
PLoS One. 2019 Aug 22;14(8):e0221427. doi: 10.1371/journal.pone.0221427. eCollection 2019.
This study aimed to evaluate the accuracy of the Xpert MTB/RIF assay for the diagnosis of bone and joint tuberculosis.
We searched databases from their inception to May 7, 2019 for published articles and reviewed them to assess the accuracy of Xpert MTB/RIF with respect to a composite reference standard (CRS) and mycobacterial culture. Meta-analyses were performed using a bivariate random-effects model, and the sources of heterogeneity were assessed via subgroup analysis and meta-regression.
Nineteen independent (9 prospective, 5 retrospective, and 5 case-control) studies that compared Xpert MTB/RIF with the CRS and 14 (6 prospective, 7 retrospective, and 1 case-control) studies that compared it with culture were included. The pooled sensitivity and specificity of Xpert MTB/RIF were 81% (95% confidence interval [CI], 77-84) and 99% (95% CI, 97-100) compared to the CRS, respectively, and 96% (95% CI, 90-98) and 85% (95% CI, 57-96) compared to culture, respectively. The pooled sensitivity and specificity using pus samples vs. the CRS were 82% (95% CI, 76-86) and 99% (95% CI, 95-100), respectively. The proportions obtained while working with tissue samples vs. the CRS were 84% (95% CI, 76-90) and 98% (95% CI, 94-99), respectively. There was no significant difference in diagnostic accuracy among the types of specimens.
Xpert MTB/RIF demonstrates good diagnostic accuracy for bone and joint tuberculosis, the results of which are not related to the type of specimen.
本研究旨在评估 Xpert MTB/RIF 检测在诊断骨与关节结核中的准确性。
我们检索了从建库至 2019 年 5 月 7 日已发表的文献，并对其进行了评估，以确定 Xpert MTB/RIF 检测对复合参考标准（CRS）和分枝杆菌培养的准确性。采用双变量随机效应模型进行荟萃分析，并通过亚组分析和元回归评估异质性来源。
共纳入 19 项独立（9 项前瞻性、5 项回顾性和 5 项病例对照研究）比较 Xpert MTB/RIF 与 CRS 的研究，以及 14 项（6 项前瞻性、7 项回顾性和 1 项病例对照研究）比较 Xpert MTB/RIF 与培养的研究。与 CRS 相比，Xpert MTB/RIF 的 pooled 敏感性和特异性分别为 81%（95%CI，77%-84%）和 99%（95%CI，97%-100%），与培养相比，分别为 96%（95%CI，90%-98%）和 85%（95%CI，57%-96%）。与 CRS 相比，使用脓液样本的 pooled 敏感性和特异性分别为 82%（95%CI，76%-86%）和 99%（95%CI，95%-100%）。与 CRS 相比，使用组织样本的 pooled 敏感性和特异性分别为 84%（95%CI，76%-90%）和 98%（95%CI，94%-99%）。不同类型的标本在诊断准确性方面没有显著差异。
Xpert MTB/RIF 对骨与关节结核具有良好的诊断准确性，其结果与标本类型无关。
