摘要
目的通过Meta分析探讨宏基因组二代测序(mNGS)对结核性脑膜炎(TBM)的诊断价值,旨在为TBM的诊断和治疗提供科学依据。方法检索PubMed、Scopus、Cochrane library、Embase、万方数据库、中国知网和中国生物医学文献数据库,收集相关研究数据。采用Meta分析评估mNGS对TBM的诊断价值。结果共纳入11篇文献,涉及TBM患者435例及非TBM患者454例。mNGS诊断TBM的合并灵敏度为0.65[95%CI(0.61~0.70)],合并特异度为0.98[95%CI(0.96~0.99)],合并阳性似然比为12.09[95%CI(6.68~21.87)],合并阴性似然比(NLR)为0.38[95%CI(0.28~0.53)],合并诊断比值比为32.73[95%CI(14.39~74.45)],综合受试者工作特征曲线下面积(AUC)为0.95(Q^(*)=0.89)。合并灵敏度和合并NLR的异质性均较大,但不存在阈值效应。亚组分析结果表明,回顾性研究组合并灵敏度高于前瞻性研究组,差异有统计学意义(P=0.019);回顾性研究组合并特异度与前瞻性研究组比较,差异无统计学意义(P=0.196)。结论mNGS对TBM的诊断具有良好的特异度和AUC,但灵敏度中等。因此,应开发更为灵敏的检测方法,以辅助诊断TBM。
Objective To explore the diagnostic value of metagenomic next generation sequencing(mNGS)in tuberculous meningitis(TBM)through Meta-analysis,aiming to provide a scientific basis for diagnosis and treatment of TBM.Methods PubMed,Scopus,Cochrane library,Embase,Wanfang Database,China National Knowledge Infrastructure(CNKI)and China Biology Medicine Disc(CBM)were searched to collect relevant research data.Meta-analysis was used to evaluate the diagnostic value of mNGS for TBM.Results A total of 11 articles were included,involving 435 TBM patients and 454 non-TBM patients.The pooled sensitivity,specificity and positive likelihood ratio of mNGS in the diagnosis of TBM were 0.65[95%CI(0.61-0.70)],0.98[95%CI(0.96-0.99)]and 12.09[95%CI(6.68-21.87)]respectively.The integrated negative likelihood ratio(NLR)was 0.38[95%CI(0.28-0.53)],the pooled diagnostic odds ratio was 32.73[95%CI(14.39-74.45)],and the integrated area under the receiver operating characteristic curve(AUC)was 0.95(Q^(*)=0.89).The heterogeneity of pooled sensitivity and pooled NLR was large,but there was no threshold effect.The results of subgroup analysis showed that the pooled sensitivity of the retrospective study group was higher than that of the prospective study group,and the difference was statistically significant(P=0.019).There was no significant difference in the combined specificity between the retrospective study group and the prospective study group(P=0.196).Conclusion mNGS has good specificity and AUC for the diagnosis of TBM,but moderate sensitivity.Therefore,more sensitive detection methods should be developed to assist the diagnosis of TBM.
作者
李世超
张冀
陈高艳
童艳飞
LI Shichao;ZHANG Ji;CHEN Gaoyan;TONG Yanfei(Department of Medical Laboratory,Affiliated Hospital of Hubei University of Arts and Sciences/Xiangyang Central Hospital,Xiangyang,Hubei 441021,China;Department of Pediatrics,Affiliated Hospital of Hubei University of Arts and Sciences/Xiangyang Central Hospital,Xiangyang,Hubei 441021,China;Department of Neurology,Affiliated Hospital of Hubei University of Arts and Sciences/Xiangyang Central Hospital,Xiangyang,Hubei 441021,China)
出处
《检验医学与临床》
CAS
2024年第22期3316-3320,共5页
Laboratory Medicine and Clinic
基金
国家自然科学基金资助项目(82304993)
湖北省自然科学基金资助项目(2022CFB370)。
