Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Department of Respiratory Medicine, Tokyo University, Tokyo, Japan.
Respir Investig. 2022 Mar;60(2):205-214. doi: 10.1016/j.resinv.2021.11.011. Epub 2021 Dec 28.
Urinary antigen tests (UATs) have been used for the early detection of legionellosis and have demonstrated moderate sensitivity and high specificity. However, the most recent systematic review and meta-analysis published in 2009 evaluated the accuracy of UATs; since then, UAT accuracy may have changed owing to advances and developments in UAT technology and epidemiological changes in the frequency of Legionella species that cause legionellosis. Therefore, this systematic review and meta-analysis aimed to update the accuracy of UATs for legionellosis among patients with suspected pneumonia.
Overall, 1326 studies were screened, 21 of which fulfilled the eligibility criteria for quality assessment and meta-analysis. Data from 5772 patients, including 1368 (23.7%) with the target condition (i.e., suspected legionellosis), were included in the analysis. The overall quality of the included studies, which was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool, was unclear.
The calculated pooled sensitivity and specificity were 0.79 (95% confidence interval [CI], 0.71-0.85) and 1.00 (95% CI, 0.99-1.00), respectively. Subpopulation analysis revealed that the accuracy of UATs for sensitivity and specificity for Legionella pneumophilia serogroup 1 was 0.86 (95% CI, 0.78-0.91) and 1.00 (95% CI, 0.99-1.00), respectively.
This study demonstrated that the sensitivity and specificity of UATs were moderate and high, respectively, which is comparable to the results reported in 2009. Therefore, UATs may be a useful method for the early detection of legionellosis caused by Legionella pneumophila serogroup 1.
The review protocol was prospectively registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN000041080).
尿抗原检测（UAT）已被用于军团菌病的早期检测，其具有中等的敏感性和高度的特异性。然而，2009 年发表的最近的系统性综述和荟萃分析评估了 UAT 的准确性；此后，由于 UAT 技术的进步和发展以及引起军团病的军团菌种类的流行率的变化，UAT 的准确性可能已经发生了变化。因此，本系统性综述和荟萃分析旨在更新 UAT 对疑似肺炎患者的军团菌病的准确性。
共筛选出 1326 项研究，其中 21 项符合质量评估和荟萃分析的纳入标准。分析纳入了 5772 例患者的数据，其中 1368 例（23.7%）患有目标疾病（即疑似军团病）。使用诊断准确性研究质量评估工具（Quality Assessment of Diagnostic Accuracy Studies-2）对纳入研究的整体质量进行了评估，其质量尚不清楚。
计算出的 UAT 敏感性和特异性的汇总值分别为 0.79（95%置信区间[CI]，0.71-0.85）和 1.00（95%CI，0.99-1.00）。亚人群分析显示，UAT 对嗜肺军团菌血清群 1 的敏感性和特异性的准确性分别为 0.86（95%CI，0.78-0.91）和 1.00（95%CI，0.99-1.00）。
本研究表明，UAT 的敏感性和特异性分别为中等和高度，与 2009 年报道的结果相当。因此，UAT 可能是一种有用的方法，用于早期检测嗜肺军团菌血清群 1 引起的军团病。
本研究方案已在大学医院医疗信息网临床试验注册系统（UMIN000041080）进行了前瞻性注册。
