背景:检测小儿中枢神经系统感染(CNSI)中的病原体仍然是医学上的主要挑战。除了传统的诊断模式,宏基因组下一代测序(mNGS)在病原体检测中显示出巨大的潜力。因此,我们系统评估了CNSI患儿脑脊液(CSF)中mNGS的诊断效能.
方法:在WebofScience中搜索了相关文献,PubMed,Embase,科克伦图书馆我们根据选择标准筛选文献并提取数据。通过诊断准确性研究质量评估-2(QUADAS-2)工具评估纳入研究的质量,并通过建议分级来衡量证据的确定性。评估,发展,和评价(等级)评分系统。然后,汇集的敏感性,特异性,正似然比(PLR),负似然比(NLR),诊断奇数比(DOR),在StataSoftware和MetaDisc中估计了总受试者工作特征曲线(sROC)的曲线下面积(AUC)。进行亚组分析以调查影响诊断性能的潜在因素。
结果:共有10项研究纳入荟萃分析。综合灵敏度为0.68(95%置信区间[CI]:0.59至0.76,I2=66.77%,p<0.001),联合特异性为0.89(95%CI:0.80至0.95,I2=83.37%,p<0.001)。sROC的AUC为0.85(95%CI,0.81~0.87)。GRADE评分系统提高的证据质量水平较低。
结论:目前的证据表明mNGS在小儿CNSI中具有良好的诊断性能。由于纳入研究的质量和数量有限,需要更多高质量的研究来验证上述结论。
BACKGROUND: Detecting pathogens in pediatric central nervous system infection (CNSI) is still a major challenge in medicine. In addition to conventional diagnostic patterns, metagenomic next-generation sequencing (mNGS) shows great potential in pathogen detection. Therefore, we systematically evaluated the diagnostic performance of mNGS in cerebrospinal fluid (CSF) in pediatric patients with CNSI.
METHODS: Related literature was searched in the Web of Science, PubMed, Embase, and Cochrane Library. We screened the literature and extracted the data according to the selection criteria. The quality of included studies was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool and the certainty of the evidence was measured by the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) score system. Then, the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odd\'s ratio (DOR), and area under the curve (AUC) of the summary receiver operating characteristic curve (sROC) were estimated in Stata Software and MetaDisc. Subgroup analyses were performed to investigate the potential factors that influence the diagnostic performance.
RESULTS: A total of 10 studies were included in the meta-analysis. The combined sensitivity was 0.68 (95% confidence interval [CI]: 0.59 to 0.76, I2 = 66.77%, p < 0.001), and the combined specificity was 0.89 (95% CI: 0.80 to 0.95, I2 = 83.37%, p < 0.001). The AUC of sROC was 0.85 (95% CI, 0.81 to 0.87). The quality level of evidence elevated by the GRADE score system was low.
CONCLUSIONS: Current evidence shows that mNGS presents a good diagnostic performance in pediatric CNSI. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.