口腔拭子检测对肺结核诊断价值的Meta分析

doi:10.19982/j.issn.1000-6621.20240161

摘要/Abstract

摘要：

目的: 系统评价口腔拭子检测对肺结核的诊断价值。方法: 应用PubMed、Embase、Web of Science、Cochrane Library、中国知网、万方中国科技期刊数据库(Wanfang)、维普数据库(VIP)和中国生物医学文献数据库(CBM),检索建库至2024年4月12日发表的口腔拭子检测肺结核的相关文献,由2名研究者独立进行文献检索、筛选、数据提取和质量评价。采用STATA 16.0软件计算总体和亚组分析的集合敏感度、特异度、阳性似然比、阴性似然比和诊断优势比,利用Deek’s漏斗图评估发表偏倚。结果: 共检索出173条文献记录,根据纳入标准和排除标准最终纳入15篇文献。Meta分析结果显示,口腔拭子对肺结核患者诊断的合并敏感度为65.0%(95%CI:54.0%~75.0%),合并特异度为96.0%(95%CI:92.0%~98.0%)。亚组分析显示,在成年肺结核患者中,口腔拭子的诊断敏感度和特异度分别为73.0%(95%CI:64.0%~80.0%)和95.0%(95%CI:83.0%~98.0%)。而舌拭子检测肺结核的敏感度为73.0%(95%CI:63.0%~80.0%),高于脸颊拭子(52.0%,95%CI:34.0%~70.0%)。结论: 口腔拭子是诊断肺结核的一种很有前途的替代方法,并且在识别肺结核患者方面,舌拭子比脸颊拭子的敏感度更高。

关键词: 结核, 诊断, 口腔, Meta分析

Abstract:

Objective: To systematically assess the diagnostic utility of oral swab testing in identifying pulmonary tuberculosis through a comprehensive meta-analysis. Methods: We conducted a detailed search of several databases including PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, VIP, and CBM, to gather relevant studies published until April 12, 2024, that investigate the use of oral swabs for detecting pulmonary tuberculosis. Literature search, screening, data extraction, and quality evaluation were independently executed by two researchers. We employed STATA 16.0 to compute the aggregated sensitivity, specificity, positive likelihood ratios, negative likelihood ratios, and diagnostic odds ratios for both overall and subgroup analyses. Publication bias was methodically evaluated using Deek’s funnel plot analysis. Results: We retrieved a total of 173 records, of which 15 studies met the predefined inclusion and exclusion criteria. Our meta-analysis revealed that the aggregate sensitivity of oral swabs for the diagnosis of pulmonary tuberculosis was 65.0% (95%CI: 54.0%-75.0%), while the overall specificity reached 96.0% (95%CI: 92.0%-98.0%). In subgroup analyses focusing on adult patients with pulmonary tuberculosis, oral swabs demonstrated a sensitivity of 73.0% (95%CI: 64.0%-80.0%) and a specificity of 95.0% (95%CI: 83.0%-98.0%).The sensitivity of tongue swabs in diagnosing pulmonary tuberculosis was 73.0% (95%CI: 63.0%-80.0%), surpassing that of cheek swabs, which registered a sensitivity of 52.0% (95%CI: 34.0%-70.0%). Conclusion: Oral swabs represent a viable alternative diagnostic tool for pulmonary tuberculosis. Notably, tongue swabs exhibit greater sensitivity compared to cheek swabs in detecting pulmonary tuberculosis cases.

Key words: Tuberculosis, Diagnosis, Oral cavity, Meta-analysis

中图分类号:

R52
R540.4

吴进凤, 杨震, 张福真, 姚丛. 口腔拭子检测对肺结核诊断价值的Meta分析[J]. 中国防痨杂志, 2024, 46(7): 815-822. doi: 10.19982/j.issn.1000-6621.20240161

Wu Jinfeng, Yang Zhen, Zhang Fuzhen, Yao Cong. Meta-analysis of the diagnostic value of oral swab for pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2024, 46(7): 815-822. doi: 10.19982/j.issn.1000-6621.20240161

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参考文献 34

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纳入研究	发表年份	国家	研究人群	样本量 (对照/ 确诊例数)	检测样本	检测方法	参照标准	TP (例)	FP (例)	FN (例)	TN (例)
Wood等^[14]	2015	南非和美国	成年人	20/20	脸颊拭子	qPCR	Xpert	18	0	2	20
Nicol等^[15]	2019	南非	儿童	44/40	脸颊拭子	qPCR	Xpert或培养	17	3	23	41
Luabeya等^[16]	2019	南非	成年人	71/59	脸颊拭子、舌拭子和牙龈拭子	qPCR	Xpert或培养	49	6	10	65
Mesman等^[17]	2019	秘鲁	成年人	26/33	脸颊拭子	Xpert Ultra	培养	15	0	18	26
Lima等^[18]	2020	巴西	NA	128/128	舌拭子	Xpert Ultra	Xpert	66	0	62	128
Flores等^[12]	2020	秘鲁	儿童	199/24	脸颊拭子	qPCR	培养	5	2	19	197
Mesman等^[19]	2020	秘鲁	成年人	30/123	脸颊拭子	qPCR	培养	63	1	60	29
Song等^[20]	2021	中国	成年人	55/46	舌拭子	TB-LAMP	Xpert和(或)培养	38	3	8	52
Wood等(1)^[21]	2021	乌干达和美国	成年人	52/50	舌拭子	qPCR	Xpert	44	11	6	42
Wood等(2)^[21]	2021	乌干达和美国	成年人	56/47	舌拭子	培养	培养	43	19	4	37
Cox等^[22]	2022	南非	儿童	201/90	舌拭子和腮拭子	Xpert Ultra	Xpert和(或)培养	20	1	70	200
Kang等^[23]	2022	韩国	成年人	144/99	舌拭子	SLIM	培养	64	20	35	124
Shapiro等^[24]	2022	南非	成年人	67/64	舌拭子	qPCR	Xpert Ultra或培养	42	15	22	52
Andama等(1)^[25]	2022	乌干达	成年人	119/58	舌拭子	Xpert Ultra	Xpert Ultra或培养	42	0	16	119
Andama等(2)^[25]	2022	乌干达	成年人	2/35	舌拭子	Xpert Ultra	Xpert Ultra或培养	27	0	8	2
LaCourse等^[26]	2022	肯尼亚	NA	80/20	脸颊拭子	qPCR	Xpert或培养	13	15	7	65
Ahls等(1)^[27]	2024	南非	成年人	220/96	舌拭子	Truenat MTB Plus	Xpert Ultra或培养	52	2	44	218
Ahls等(2)^[27]	2024	南非	成年人	224/96	舌拭子	In-house qPCR	Xpert Ultra或培养	67	8	29	216

亚组	敏感度 (%,95%CI)	特异度 (%,95%CI)	阳性似然比 (95%CI)	阴性似然 (95%CI)	诊断比值比 (95%CI)	曲线下面积 (95%CI)
研究人群
成年人	73.0 (64.0~80.0)	95.0 (88.0~98.0)	14.9 (0.21~0.38)	0.28 (0.21~0.38)	52 (23~122)	0.89 (0.86~0.92)
儿童	21.0~43.0^a	93.0~100.0^a	-	-	-	-
检测样本
舌拭子	73.0 (63.0~80.0)	95.0 (85.0~99.0)	15.5 (5.0~47.6)	0.29 (0.22~0.38)	54 (18~157)	0.87 (0.83~0.89)
脸颊拭子	52.0 (34.0~70.0)	97.0 (89.0~99.0)	15.9 (4.6~54.8)	0.49 (0.34~0.72)	32 (8~124)	0.88 (0.85~0.91)
检测方法
qPCR	66.0 (50.0~79.0)	93.0 (86.0~97.0)	9.5 (5.0~18.1)	0.36 (0.24~0.55)	26 (13~54)	0.90 (0.87~0.92)
Xpert Ultra	22.0~77.0^a	99.0~100.0^a	-	-	-	-
qPCR法检测不同样本
舌拭子	66.0~88.0	78.0~96.0	-	-	-	-
脸颊拭子	54.0 (32.0~75.0)	96.0 (87.0~99.0)	12.9 (4.0~41.6)	0.48 (0.29~0.78)	27 (7~104)	0.89 (0.86~0.92)