Zhejiang Tuberculosis Diagnosis and Treatment Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, Zhejiang, China.
Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou, Zhejiang, China.
Medicine (Baltimore). 2022 May 20;101(20):e29363. doi: 10.1097/MD.0000000000029363.
The aim of this study was to evaluate the diagnostic accuracy of Xpert MTB/RIF Ultra (Xpert Ultra) and Xpert MTB/RIF (Xpert) for the diagnosis of tuberculous pleurisy (TBP) head-to-head using meta-analysis method.
On May 12, 2021, we searched multiple databases for reports that used Xpert Ultra and Xpert for TBP diagnosis head-to-head and screened eligible studies for inclusion. Accuracy of Xpert Ultra and Xpert were compared to that of the composite reference standard (CRS) and culture. When heterogeneity was evident, sources of heterogeneity were explored using subgroup analyses, sensitivity analysis, and meta-regression analyses.
Five articles met the inclusion criteria for meta-analysis. When results from different specimens or different reference standards were reported in the same article, we analyzed them as separate studies. Thus, 6 studies compared Xpert Ultra and Xpert with CRS, 5 studies compared Xpert Ultra and Xpert with culture. Pooled sensitivity and specificity of Xpert Ultra were 52% and 98% compared to CRS, and 82% and 77% compared to culture. Pooled sensitivity and specificity of Xpert were 22% and 99% compared to CRS, and 48% and 94% compared to culture. Significant heterogeneity in sensitivity was observed compared to CRS.
The sensitivity of Xpert Ultra was moderate but better than that of the Xpert; however, its specificity was lower. The role of Xpert Ultra and Xpert in the early and rapid diagnosis of TBP was limited.
本研究旨在使用荟萃分析方法评估 Xpert MTB/RIF Ultra（Xpert Ultra）和 Xpert MTB/RIF（Xpert）对头对头诊断结核性胸膜炎（TBP）的诊断准确性。
2021 年 5 月 12 日，我们检索了多个数据库，以查找使用 Xpert Ultra 和 Xpert 对头对头诊断 TBP 的报告，并筛选出符合纳入标准的研究。比较了 Xpert Ultra 和 Xpert 与复合参考标准（CRS）和培养物的准确性。当存在异质性时，使用亚组分析、敏感性分析和荟萃回归分析来探讨异质性的来源。
有 5 篇文章符合荟萃分析的纳入标准。当同一篇文章中报告了来自不同标本或不同参考标准的结果时，我们将其作为单独的研究进行分析。因此，有 6 项研究比较了 Xpert Ultra 和 Xpert 与 CRS，5 项研究比较了 Xpert Ultra 和 Xpert 与培养物。与 CRS 相比，Xpert Ultra 的汇总敏感性和特异性分别为 52%和 98%，与培养物相比分别为 82%和 77%。与 CRS 相比，Xpert 的汇总敏感性和特异性分别为 22%和 99%，与培养物相比分别为 48%和 94%。与 CRS 相比，敏感性存在显著异质性。
Xpert Ultra 的敏感性中等，但优于 Xpert；然而，其特异性较低。Xpert Ultra 和 Xpert 在 TBP 的早期和快速诊断中的作用有限。
