Lin Hsiu-Ling, Chen Hui-Mei, Lin Chih-Yen, Chen Cheng-Chieh
Department of Nursing, Landseed International Hospital, Taoyuan, Taiwan.
Department of Pathology and Laboratory Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Trop Med Int Health. 2023 Oct;28(10):797-805. doi: 10.1111/tmi.13928. Epub 2023 Aug 28.
Neisseria meningitidis is one of the major pathogens of meningitis in children worldwide and causes invasive meningococcal disease (IMD), which is a critical illness that mainly presents as meningitis and/or septicemia in children. Identification of N. meningitidis in cerebrospinal fluid (CSF) is the gold standard for the diagnosis of meningococcal meningitis, but antigen tests have advantages such as timely results, relatively low cost, and convenience. Yet, the diagnostic accuracy of antigen tests remains uncertain. Therefore, the aim of this meta-analysis was to evaluate the diagnostic accuracy of antigen tests for N. meningitidis in CSF.
We searched the PubMed, Embase, and Cochrane Library databases for studies evaluating the diagnostic accuracy of antigen tests for N. meningitidis in CSF. We included studies that provided sufficient data to construct a 2 × 2 table on a per-sample basis. To determine the overall sensitivity and specificity of the antigen tests, we used polymerase chain reaction (PCR) as the reference standard and employed the hierarchical summary receiver operating characteristic model.
Nine studies with 4533 CSF samples were included. The meta-analysis yielded a pooled sensitivity of 91.2% (95% confidence interval [CI]: 80.0%-100.0%) and a pooled specificity of 93.8% (95% CI: 83.9%-100.0%). A subgroup analysis of 2 studies that reported the outcomes of MeningoSpeed yielded a pooled sensitivity of 93.4% (95% CI: 90.0%-95.8%) and a pooled specificity of 91.9% (95% CI: 88.6%-94.4%). Antigen testing for the N. meningitidis serogroup X had a pooled sensitivity of 92.4% (95% CI: 85.2%-96.2%) and a pooled specificity of 99.2% (95% CI: 78.7%-100.0%).
The studied antigen tests had high sensitivity and specificity for the diagnosis of meningococcal meningitis in CSF specimens. Antigen testing could serve as an accurate diagnostic method for assessing patients who have a suspected N. meningitidis infection.
脑膜炎奈瑟菌是全球儿童脑膜炎的主要病原体之一，可导致侵袭性脑膜炎球菌病（IMD），这是一种主要表现为儿童脑膜炎和/或败血症的重症疾病。脑脊液（CSF）中脑膜炎奈瑟菌的鉴定是诊断脑膜炎球菌性脑膜炎的金标准，但抗原检测具有结果及时、成本相对较低且方便等优点。然而，抗原检测的诊断准确性仍不确定。因此，本荟萃分析的目的是评估CSF中脑膜炎奈瑟菌抗原检测的诊断准确性。
我们在PubMed、Embase和Cochrane图书馆数据库中检索了评估CSF中脑膜炎奈瑟菌抗原检测诊断准确性的研究。我们纳入了提供足够数据以逐个样本构建2×2表格的研究。为了确定抗原检测的总体敏感性和特异性，我们使用聚合酶链反应（PCR）作为参考标准，并采用分层汇总接受者操作特征模型。
纳入了9项研究，共4533份CSF样本。荟萃分析得出合并敏感性为91.2%（95%置信区间[CI]：80.0%-100.0%），合并特异性为93.8%（95%CI：83.9%-100.0%）。对2项报告了MeningoSpeed结果的研究进行的亚组分析得出合并敏感性为93.4%（95%CI：90.0%-95.8%），合并特异性为91.9%（95%CI：88.6%-94.4%）。X群脑膜炎奈瑟菌的抗原检测合并敏感性为92.4%（95%CI：85.2%-96.2%），合并特异性为99.2%（95%CI：78.7%-100.0%）。
所研究的抗原检测对CSF标本中脑膜炎球菌性脑膜炎的诊断具有高敏感性和特异性。抗原检测可作为评估疑似脑膜炎奈瑟菌感染患者的准确诊断方法。
