Gong Ren-Jie, Xu Can-Xia, Li Huan, Liu Xiao-Ming
Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China.
World J Clin Cases. 2021 Jan 6;9(1):133-147. doi: 10.12998/wjcc.v9.i1.133.
() infection is closely associated with the etiology of a variety of gastric diseases. The effective eradication of infection has been shown to reduce the incidence of gastric carcinoma. However, the rate of eradication has significantly declined due to its increasing resistance to antibiotics, especially to clarithromycin. Therefore, the detection of clarithromycin resistance is necessary prior to the treatment of Although many studies have been conducted on the use of polymerase chain reaction (PCR)-based tests to detect clarithromycin resistance in stool samples, no accurate data on the feasibility of these tests are available. Here, we performed a meta-analysis to assess the feasibility of these noninvasive tests.
To evaluate the reliability of PCR-based tests for detecting clarithromycin resistance in stool samples.
We searched PubMed, Medline, Embase, and other databases for articles that evaluated the value of the PCR analysis of stool samples for detecting the resistance of to clarithromycin. We collected cross-sectional studies that met the inclusion criteria. Diagnostic accuracy measures were pooled using a random-effects model. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Subgroup analysis was also conducted according to PCR type, purification technique, reference standard, mutation site, sample weight, number of patients, and age group, and the clinical utility of diagnostic tests was evaluated using the Likelihood Ratio Scatter Graph.
Out of the 1818 identified studies, only 11 met the eligibility criteria, with a total of 592 patients assessed. A meta-analysis of the random-effect model showed that PCR-based analysis of stool samples had high diagnostic accuracy for detecting clarithromycin resistance in patients infected with . The combined sensitivity was 0.91 [95% confidence interval (CI): 0.83-0.95], Q = 30.34, and = 67.04, and the combined specificity was 0.97 (95%CI: 0.62-1.00), Q = 279.54, and = 96.42. The likelihood ratio for a positive test was 33.25 (95%CI: 1.69-652.77), and that for a negative test was 0.10 (95%CI: 0.05-0.18), with an area under the curve of 0.94. The diagnostic odds ratio was 347.68 (95%CI: 17.29-6991.26). There was significant statistical heterogeneity, and the sub-analyses showed significant differences in the number of patients, sample weight, purification methods, PCR types, mutation points, and reference standards. The included studies showed no risk of publication bias.
PCR-based tests on stool samples have high diagnostic accuracy for detecting clarithromycin resistance.
（）感染与多种胃部疾病的病因密切相关。已证明有效根除该感染可降低胃癌的发病率。然而，由于其对抗生素（尤其是克拉霉素）的耐药性增加，根除率已显著下降。因此，在治疗该感染之前检测克拉霉素耐药性是必要的。尽管已经进行了许多关于使用基于聚合酶链反应（PCR）的检测来检测粪便样本中克拉霉素耐药性的研究，但尚无关于这些检测可行性的准确数据。在此，我们进行了一项荟萃分析以评估这些非侵入性检测的可行性。
评估基于PCR的检测在粪便样本中检测该感染克拉霉素耐药性的可靠性。
我们在PubMed、Medline、Embase和其他数据库中搜索评估粪便样本PCR分析检测该感染对克拉霉素耐药性价值的文章。我们收集了符合纳入标准的横断面研究。使用随机效应模型汇总诊断准确性指标。使用诊断准确性研究质量评估-2工具评估偏倚风险。还根据PCR类型、纯化技术、参考标准、突变位点、样本重量、患者数量和年龄组进行了亚组分析，并使用似然比散点图评估诊断试验的临床实用性。
在1818项已识别的研究中，只有11项符合纳入标准，共评估了59位患者。随机效应模型的荟萃分析表明，基于PCR的粪便样本分析在检测该感染患者的克拉霉素耐药性方面具有较高的诊断准确性。合并敏感性为0.91[95%置信区间（CI）：0.83 - 0.95]，Q = 30.34，I² = 67.04，合并特异性为0.97（95%CI：0.62 - 1.00），Q = 279.54，I² = 96.42。阳性检测的似然比为33.25（95%CI：1.69 - 652.77），阴性检测的似然比为0.10（95%CI：0.05 - 0.18），曲线下面积为0.94。诊断比值比为347.68（95%CI：17.29 - 6991.26）。存在显著的统计学异质性，亚分析显示在患者数量、样本重量、纯化方法、PCR类型、突变点和参考标准方面存在显著差异。纳入的研究未显示发表偏倚风险。
基于PCR的粪便样本检测在检测该感染克拉霉素耐药性方面具有较高的诊断准确性。
