探讨Xpert MTB/RIF检测法在检测淋巴结结核中的准确性：一项系统评价和荟萃分析。
Exploring the accuracy of the Xpert MTB/RIF assay in detecting lymph node tuberculosis: A systematic review and meta-analysis.
作者信息
Chen Zi-Ke, Wu Zhao, Ye Ting, Lin Chao-Yang, Guo Xu-Guang
机构信息
Department of Clinical Laboratory Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, China.
出版信息
PLoS One. 2025 May 7;20(5):e0321507. doi: 10.1371/journal.pone.0321507. eCollection 2025.
BACKGROUND
The Xpert MTB/RIF assay has exhibited high diagnostic efficiency in detecting lymph node tuberculosis (LNTB). However, different gold standards and types of LNTB specimens may impact Xpert's diagnostic accuracy. This meta-analysis compared the performance of Xpert MTB/RIF on fine needle aspiration (FNA) and tissue samples against that of culture and composite reference standards (CRS) for LNTB diagnosis. In addition, we further reported the diagnostic accuracy of the Xpert MTB/RIF assay in identifying LNTB in different age groups and rifampicin resistance in LNTB patients.
METHODS
A systematic search of Embase, Cochrane Library, PubMed, Web of Science, and Scopus up to October 26, 2023, was conducted. Studies comparing Xpert MTB/RIF with culture and CRS were selected. Meta-analyses and meta-regression were performed using Stata and Meta Disc software.
RESULTS
In 9 studies, Xpert MTB/RIF was compared with CRS, while in 24 studies, it was compared with culture. The sensitivity and specificity of the Xpert MTB/RIF test were 85% and 97%, respectively, against CRS and 85% and 78%, respectively, against culture. FNA sensitivity and specificity were 93% and 88% respectively against CRS and 87% and 77% respectively against culture. For tissue samples, the sensitivity and specificity were 74% and 100%, respectively, against CRS and 74% and 77%, respectively, against culture. For the adult cohort (>14 years), the sensitivity and specificity of FNA samples were 80% and 75% against culture and 85% and 88% respectively against CRS. The pooled sensitivity and specificity of Xpert for detecting rifampicin resistance were 90% and 99% respectively.
CONCLUSION
Xpert MTB/RIF demonstrated excellent accuracy for diagnosing LNTB and rifampicin resistance, with FNA samples outperforming tissue samples acquired through biopsy and CRS as superior to culture standards.
背景
Xpert MTB/RIF检测在检测淋巴结结核（LNTB）方面显示出较高的诊断效率。然而，不同的金标准和LNTB标本类型可能会影响Xpert的诊断准确性。本荟萃分析比较了Xpert MTB/RIF对细针穿刺抽吸（FNA）和组织样本的检测性能与用于LNTB诊断的培养和综合参考标准（CRS）的性能。此外，我们进一步报告了Xpert MTB/RIF检测在识别不同年龄组LNTB以及LNTB患者利福平耐药性方面的诊断准确性。
方法
对截至2023年10月26日的Embase、Cochrane图书馆、PubMed、Web of Science和Scopus进行系统检索。选择比较Xpert MTB/RIF与培养及CRS的研究。使用Stata和Meta Disc软件进行荟萃分析和荟萃回归。
结果
在9项研究中，将Xpert MTB/RIF与CRS进行了比较，而在24项研究中，将其与培养进行了比较。Xpert MTB/RIF检测针对CRS的敏感性和特异性分别为85%和97%，针对培养的敏感性和特异性分别为85%和78%。FNA针对CRS的敏感性和特异性分别为93%和88%，针对培养的敏感性和特异性分别为87%和77%。对于组织样本，针对CRS的敏感性和特异性分别为74%和100%，针对培养的敏感性和特异性分别为74%和77%。对于成人队列（>14岁），FNA样本针对培养的敏感性和特异性分别为80%和75%，针对CRS的敏感性和特异性分别为85%和88%。Xpert检测利福平耐药性的合并敏感性和特异性分别为90%和99%。
结论
Xpert MTB/RIF在诊断LNTB和利福平耐药性方面显示出优异的准确性，FNA样本的表现优于通过活检获取的组织样本，且CRS优于培养标准。
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