Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario L8S 4K1, Canada; Microbiology Department, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Ontario L8L 2X2, Canada.
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario L8S 4K1, Canada.
Clin Biochem. 2023 Jul;117:84-93. doi: 10.1016/j.clinbiochem.2022.08.004. Epub 2022 Aug 8.
Nucleic acid amplification testing (NAAT) is the preferred method to diagnose coronavirus disease 2019 (COVID-19). Saliva has been suggested as an alternative to nasopharyngeal swabs (NPS), but previous systematic reviews were limited by the number and types of studies available. The objective of this systematic review and meta-analysis was to assess the diagnostic performance of saliva compared with NPS for COVID-19. We searched Ovid MEDLINE, Embase, Cochrane, and Scopus databases up to 24 April 2021 for studies that directly compared paired NPS and saliva specimens taken at the time of diagnosis. Meta-analysis was performed using an exact binomial rendition of the bivariate mixed-effects regression model. Risk of bias was assessed using the QUADAS-2 tool. Of 2683 records, we included 23 studies with 25 cohorts, comprising 11,582 paired specimens. A wide variety of NAAT assays and collection methods were used. Meta-analysis gave a pooled sensitivity of 87 % (95 % CI = 83-90 %) and specificity of 99 % (95 % CI = 98-99 %). Subgroup analyses showed the highest sensitivity when the suspected individual is tested in an outpatient setting and is symptomatic. Our results support the use of saliva NAAT as an alternative to NPS NAAT for the diagnosis of COVID-19.
核酸扩增检测（NAAT）是诊断 2019 年冠状病毒病（COVID-19）的首选方法。唾液已被提议作为鼻咽拭子（NPS）的替代物，但以前的系统评价受到现有研究数量和类型的限制。本系统评价和荟萃分析的目的是评估唾液与 NPS 相比在 COVID-19 诊断中的诊断性能。我们在 2021 年 4 月 24 日之前在 Ovid MEDLINE、Embase、Cochrane 和 Scopus 数据库中搜索了直接比较同时采集的 NPS 和唾液标本的研究。使用二变量混合效应回归模型的精确二项式演绎进行荟萃分析。使用 QUADAS-2 工具评估偏倚风险。在 2683 条记录中，我们纳入了 23 项研究，共 25 个队列，包括 11582 对标本。使用了各种 NAAT 检测和采集方法。荟萃分析得出的合并敏感性为 87%（95%CI=83-90%），特异性为 99%（95%CI=98-99%）。亚组分析表明，在门诊环境中对疑似个体进行检测且有症状时，敏感性最高。我们的结果支持使用唾液 NAAT 替代 NPS NAAT 来诊断 COVID-19。
