SAT-TB检测肺泡灌洗液对肺结核诊断价值的Meta分析

Meta-Analysis of the Diagnostic Value of SAT-TB for Alveolar Lavage Fluid in the Diagnosis of Pulmonary Tuberculosis

摘要: 目的：通过Meta分析评估结核分枝杆菌RNA恒温扩增检测(simultaneous amplification and testing for Mycobacterium tuberculosis, SAT-TB)支气管肺泡灌洗液对肺结核的诊断价值。方法：通过检索万方、维普、中国知网、PubMed、Embase等数据库，检索从建库至2020年6月20日前发表的与SAT-TB检测肺泡灌洗液诊断肺结核相关的文献，筛选文献，阅读全文并提取纳入文献的原始数据，使用Review Manager 5.3根据诊断精确性研究质量评估工具(QUADAS-2)评估纳入文献的质量。使用Meta-Disc 1.4对纳入文献提取的数据进行分析，判断是否存在异质性，绘制森林图及SROC曲线图，计算汇总灵敏度、特异度、似然比、诊断比值比及其95%可信区间。结果：共检索出182篇文献，依据文献纳入和排除标准，共纳入15篇文献。SAT-TB技术检测肺泡灌洗液诊断肺结核，汇总灵敏度0.58 (95%CI: 0.57~0.59)、汇总特异度0.95 (95%CI: 0.95~0.96)，汇总阳性似然比15.16 (95%CI: 7.85~29.29)，汇总阴性似然比0.37 (95%CI: 0.31~0.45)，汇总诊断比值比40.89 (95%CI: 24.34~68.70)。绘制SROC显示AUC = 0.87。结论：SAT-TB检测支气管肺泡灌洗液诊断肺结核有较高的诊断价值，可作为诊断菌阴性肺结核的有效方法。

Abstract: Objective: By meta-analysis to assess the diagnostic value of Mycobacterium tuberculosis RNA sim-ultaneous amplification and testing for Mycobacterium tuberculosis (SAT-TB) in bronchoalveolar lavage for the diagnosis of pulmonary TB. Method: The literature related to SAT-TB testing alveolar lavage fluid for the diagnosis of TB was searched by searching the databases of Wanfang, Wipu, China National Knowledge Infrastructure, PubMed and Embase from the time the database that was built to 20 June 2020, screening the literature, reading the full text and extracting the raw data of the included literature, and using Review Manager 5.3 to assess the quality of the included litera-ture according to the Diagnostic Accuracy Study Assessment tool (QUADAS-2). Data extracted from the included literature were analysed for heterogeneity using Meta-Disc 1.4, forest plots and SROC plots were drawn, and summary sensitivities, specificities, likelihood ratios, diagnostic ratios and their 95% confidence intervals were calculated. Results: A total of 182 papers were searched and 15 papers were included according to the inclusion and exclusion criteria. The SAT-TB technique for alveolar lavage fluid diagnosis of tuberculosis had a pooled sensitivity of 0.58 (95%CI: 0.57~0.59), a pooled specificity of 0.95 (95%CI: 0.95~0.96), a pooled positive likelihood ratio of 15.16 (95%CI: 7.85~29.29), a pooled negative likelihood ratio of 0.37 (95%CI: 0.31~0.45) and a pooled diagnostic ratio of 40.89 (95%CI: 24.34~68.45). Plotting the SROC showed an AUC = 0.87. Conclusions: SAT-TB test for bronchoalveolar lavage fluid has a high diagnostic value for the diagnosis of pulmonary tu-berculosis and can be used as an effective method for the diagnosis of bacillary negative tuberculo-sis.