Chew Natalie, Yun Sean, See Kay Choong
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Department of Medicine, National University Hospital, NUHS Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore.
Lung. 2025 Jan 22;203(1):26. doi: 10.1007/s00408-024-00779-y.
Tuberculosis (TB) is a highly contagious infection and one of the world's leading causes of death from a single infectious agent. Currently, TB diagnosis can be established via mycobacterial cultures, Acid Fast Bacilli smear and molecular studies. In the ever-evolving landscape of medical advancements, breath tests have shown considerable promise. This systematic review aimed to evaluate the diagnostic accuracy of breath tests to detect pulmonary TB in various populations.
This systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. We searched Embase and PubMed to identify observational studies published from database inception to May 2024. All observational studies evaluating the diagnostic accuracy of breath tests to detect pulmonary tuberculosis were included. Authors independently reviewed each article for eligibility and risk-of-bias. A senior reviewer was consulted for discrepancies.
The pooled sensitivity for the breath test in diagnosing TB was 0.85 (95% CI 0.78-0.90) whilst the pooled specificity was 0.83 (95% CI 0.72-0.90), although heterogeneity was high. Sub-group analysis by low/lower-middle World Bank income group status, high proportion of TB in test population, or use of a separate breath sampling kit did not reduce the heterogeneity. Publication bias was absent.
Our study found that pooled sensitivity and specificity of the breath tests in diagnosing pulmonary TB was high. Future research efforts can be directed towards investigating the diagnostic accuracy of electronic noses and gas chromatography combined with mass spectrometry, whilst improving standardisation and reproducibility of breath test techniques.
结核病是一种高度传染性感染病，也是世界上由单一传染源导致死亡的主要原因之一。目前，结核病诊断可通过分枝杆菌培养、抗酸杆菌涂片及分子研究来确定。在不断发展的医学进步背景下，呼气测试已显示出相当大的前景。本系统评价旨在评估呼气测试在不同人群中检测肺结核的诊断准确性。
本系统评价按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行。我们检索了Embase和PubMed，以确定从数据库建立至2024年5月发表的观察性研究。纳入所有评估呼气测试检测肺结核诊断准确性的观察性研究。作者独立审查每篇文章的合格性和偏倚风险。如有分歧，咨询一位资深审稿人。
呼气测试诊断结核病的合并敏感性为0.85（95%CI 0.78 - 0.90），而合并特异性为0.83（95%CI 0.72 - 0.90），尽管异质性较高。按世界银行低/中低收入组状况、测试人群中结核病高比例或使用单独的呼气采样试剂盒进行亚组分析，并未降低异质性。不存在发表偏倚。
我们的研究发现，呼气测试诊断肺结核的合并敏感性和特异性较高。未来的研究工作可致力于研究电子鼻以及气相色谱结合质谱的诊断准确性，同时提高呼气测试技术的标准化和可重复性。
