泌尿生殖道结核是第三种最常见的肺外结核。由于临床表现不明确,常规检查的准确性低,诊断困难。不幸的是,延迟诊断严重影响泌尿道。核酸扩增试验产生快速结果,其中,新技术也可以检测耐药性。关于在泌尿生殖系统结核病中使用这些测试缺乏共识;因此,我们旨在评估核酸扩增测试在泌尿生殖系统结核病诊断中的准确性,并评估研究之间的异质性。
我们对研究文章进行了系统评价和荟萃分析,比较了参考标准和核酸扩增试验诊断泌尿道结核的准确性。我们搜查了Medline,EMBASE,WebofScience,LILACS,科克伦图书馆,和Scopus在1990年1月1日至2016年4月14日之间发表的文章。两名研究人员确定了符合条件的文章,并提取了各个研究地点的数据。我们用相同的指数检验对数据进行分组分析。然后,当研究不具有异质性时,我们使用随机效应荟萃分析,得出了敏感性和特异性的汇总估计值(95%CI).
我们从10篇文章中确定了11项相关研究,提供有关PCR的信息,LCR和XpertMTB/RIF测试。所有的PCR研究都是“内部”测试,具有不同的基因靶标,并且有几个质量问题,因此我们没有进行汇总分析。只有一项研究使用了LCR。Xpert研究质量好,没有异质性,合并敏感性为0·87(0·66-0·96),特异性为0·91(0·84-0·95)。
PCR研究是高度异质的。在XpertMTB/RIF研究中,特异性是有利的,具有可接受的置信区间,然而,新的研究可以更新荟萃分析并获得更精确的估计。迫切需要进一步的高质量研究来改善泌尿生殖系统结核病的诊断。
PROSPEROCRD42016039020。
Genitourinary tuberculosis is the third most common form of extrapulmonary tuberculosis. Diagnosis is difficult because of unspecific clinical manifestations and low accuracy of conventional tests. Unfortunately, the delayed diagnosis impacts the urinary tract severely. Nucleic acid amplification tests yield fast results, and among these, new technologies can also detect drug resistance. There is lack of consensus regarding the use of these tests in genitourinary tuberculosis; we therefore aimed to assess the accuracy of nucleic acid amplification tests in the diagnosis of genitourinary tuberculosis and to evaluate the heterogeneity between studies.
We did a systematic
review and meta-analysis of research articles comparing the accuracy of a reference standard and a nucleic acid amplification test for diagnosis of urinary tract tuberculosis. We searched Medline, EMBASE, Web of Science, LILACS, Cochrane Library, and Scopus for articles published between Jan 1, 1990, and Apr 14, 2016. Two investigators identified eligible articles and extracted data for individual study sites. We analyzed data in groups with the same index test. Then, we generated pooled summary estimates (95% CIs) for sensitivity and specificity by use of random-effects meta-analysis when studies were not heterogeneous.
We identified eleven relevant studies from ten articles, giving information on PCR, LCR and Xpert MTB/RIF tests. All PCR studies were \"in-house\" tests, with different gene targets and had several quality concerns therefore we did not proceed with a pooled analysis. Only one study used LCR. Xpert studies were of good quality and not heterogeneous, pooled sensitivity was 0·87 (0·66-0·96) and specificity was 0·91 (0·84-0·95).
PCR studies were highly heterogeneous. Among Xpert MTB/RIF studies, specificity was favorable with an acceptable confidence interval, however new studies can update meta-analysis and get more precise estimates. Further high-quality studies are urgently needed to improve diagnosis of genitourinary tuberculosis.
PROSPERO CRD42016039020.