Biakto Karya T, Kusmawan I Gpy, Massi Muhammad N, Usman Muhammad A, Arifin Jainal
Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Hasanuddin, Makassar, Indonesia.
Department of Orthopedic and Traumatology, Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia.
Narra J. 2024 Aug;4(2):e925. doi: 10.52225/narra.v4i2.925. Epub 2024 Aug 13.
Tuberculosis remains a significant global health issue, with spinal tuberculosis being a severe form of extrapulmonary tuberculosis. Despite the high morbidity associated with spinal tuberculosis, effective and rapid diagnostic methods are limited. The aim of this study was to evaluate the diagnostic accuracy of the GeneXpert compared to other microbiological methods in diagnosing spinal tuberculosis. A systematic review and meta-analysis were conducted following the PRISMA guidelines. Six databases (PubMed, Scopus, EBSCO, EMBASE, ScienceDirect, and Cochrane Central) were searched for relevant studies as of August 31, 2023. Studies were selected based on predefined inclusion criteria, focusing on patients diagnosed with spinal tuberculosis and comparing GeneXpert to microbiological culture, acid-fast bacilli (AFB) staining, and polymerase chain reaction (PCR). Two authors independently performed data extraction and quality assessment, and the meta-analysis was conducted using Meta-DiSc 2.0. Fourteen studies comprising retrospective cohort, prospective cohort, and cross-sectional designs were included. GeneXpert demonstrated a pooled sensitivity of 92% (85-96%) and specificity of 71% (51-86%) compared to culture. AFB smear had the highest specificity at 80% (70- 88%) but the lowest sensitivity at 27% (20-35%). The PCR had sensitivity and specificity of 83% (67-92%) and 58% (31-81%), respectively. Substantial heterogeneity was noted across the studies. This study highlighted that GeneXpert had high sensitivity and moderate specificity in diagnosing spinal tuberculosis, making it an alternative to conventional methods. However, further validation through larger, interventional studies is necessary to standardize its use in clinical practice.
结核病仍然是一个重大的全球健康问题，脊柱结核是肺外结核的一种严重形式。尽管脊柱结核的发病率很高，但有效的快速诊断方法却很有限。本研究的目的是评估与其他微生物学方法相比，GeneXpert在诊断脊柱结核方面的诊断准确性。按照PRISMA指南进行了系统评价和荟萃分析。检索了六个数据库（PubMed、Scopus、EBSCO、EMBASE、ScienceDirect和Cochrane Central），以查找截至2023年8月31日的相关研究。根据预先确定的纳入标准选择研究，重点关注被诊断为脊柱结核的患者，并将GeneXpert与微生物培养、抗酸杆菌（AFB）染色和聚合酶链反应（PCR）进行比较。两位作者独立进行数据提取和质量评估，并使用Meta-DiSc 2.0进行荟萃分析。纳入了14项包括回顾性队列、前瞻性队列和横断面设计的研究。与培养相比，GeneXpert的合并敏感性为92%（85%-96%），特异性为71%（51%-86%）。AFB涂片的特异性最高，为80%（70%-88%），但敏感性最低，为27%（20%-35%）。PCR的敏感性和特异性分别为83%（67%-92%）和58%（31%-81%）。研究中发现存在显著的异质性。本研究强调，GeneXpert在诊断脊柱结核方面具有高敏感性和中等特异性，使其成为传统方法的一种替代方法。然而，需要通过更大规模的干预性研究进行进一步验证，以规范其在临床实践中的应用。
