痰诱导与支气管镜检查在痰涂片阴性肺结核诊断中的比较：系统评价和荟萃分析。
Comparison of sputum induction and bronchoscopy in diagnosis of sputum smear-negative pulmonary tuberculosis: a systemic review and meta-analysis.
机构信息
Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Xiamen University, Xiamen, 361001, China.
Epidemiology Research Unit, the First Affiliated Hospital of Xiamen University, Xiamen, China.
出版信息
BMC Pulm Med. 2020 May 25;20(1):146. doi: 10.1186/s12890-020-01192-w.
BACKGROUND
Pulmonary tuberculosis is one of the most common infectious diseases worldwide. Patients with suspected pulmonary tuberculosis with negative smear are recommended to undergo further tests including sputum induction and bronchoscopy. Our study is aimed to compare sputum induction and bronchoscopic specimens in the diagnosis of sputum smear-negative pulmonary tuberculosis.
METHOD
PubMed, Web of Science, Cochrane Library and Embase were searched for eligible studies. The pooled sensitivities (SEN), specificities (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and 95% confidence intervals (CI) were constructed, and the areas under the curves (AUCs) were calculated.
RESULTS
Five studies with a total number of 586 cases were included. For mycobacterial culture, the SEN and SPE of sputum induction were 0.72(95% CI, 0.66-0.77) and 1.00(95%CI, 0.99-1.000) respectively, whereas the SEN and SPE of bronchoscopy were 0.70(95%CI, 0.64-0.75) and 1.00(95%CI, 0.99-1.00) respectively. Sputum induction had a similar AUC (0.9564, SE = 0.0749) with bronchoscopy (0.8618, SE = 0.1652) (P = 0.602). For specimen of acid-fast bacilli smear, the SEN and SPE of sputum induction were 0.35(95% CI, 0.29-0.42) and 0.99(95% CI, 0.96-1.00) respectively, whereas the SEN and SPE of bronchoscopy were 0.38(95% CI, 0.32-0.45) and 0.99(95% CI, 0.96-1.00) respectively. There is no statistically significant difference in the AUC for sputum induction (0.6016) compared with bronchoscopy (0.8163) (P = 0.792).
CONCLUSIONS
For the diagnosis of sputum smear-negative pulmonary tuberculosis, the diagnosis yield of sputum induction and bronchoscopy is similar.
背景
肺结核是全球最常见的传染病之一。对于疑似肺结核且痰涂片阴性的患者，建议进行痰诱导和支气管镜检查等进一步检查。本研究旨在比较痰诱导和支气管镜检查在诊断痰涂片阴性肺结核方面的效果。
方法
检索 PubMed、Web of Science、Cochrane Library 和 Embase 中符合条件的研究。构建合并后的敏感度（SEN）、特异度（SPE）、阳性似然比（PLR）、阴性似然比（NLR）、诊断比值比（DOR）和 95%置信区间（CI），并计算曲线下面积（AUC）。
结果
纳入了 5 项研究，共 586 例患者。对于分枝杆菌培养，痰诱导的 SEN 和 SPE 分别为 0.72（95%CI，0.66-0.77）和 1.00（95%CI，0.99-1.000），而支气管镜检查的 SEN 和 SPE 分别为 0.70（95%CI，0.64-0.75）和 1.00（95%CI，0.99-1.00）。痰诱导的 AUC 与支气管镜检查（0.9564，SE=0.0749）相似（0.8618，SE=0.1652）（P=0.602）。对于抗酸杆菌涂片标本，痰诱导的 SEN 和 SPE 分别为 0.35（95%CI，0.29-0.42）和 0.99（95%CI，0.96-1.00），而支气管镜检查的 SEN 和 SPE 分别为 0.38（95%CI，0.32-0.45）和 0.99（95%CI，0.96-1.00）。痰诱导与支气管镜检查的 AUC 无统计学差异（0.6016 与 0.8163）（P=0.792）。
结论
对于诊断痰涂片阴性肺结核，痰诱导和支气管镜检查的诊断效果相当。
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