诊断试验在检测Pneumocystis jirovecii中的表现:系统性审查和元分析
Ling Zhang1,2, Caopei Zheng1,3, Yuqing Sun1,3
1Department of Respiratory and Critical Care Medicine, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China.
概括
定量PCR (qPCR) 对于通过区分感染与殖民来诊断Pneumocystis jirovecii肺炎 (PJP) 是有价值的. 虽然元基因组下一代测序 (mNGS) 显示出高精度,但qPCR为临床诊断提供了可靠的选择.
科学领域:
- 医学诊断 医学诊断 医学诊断
- 传染性疾病 传染性疾病
- 微生物学 微生物学
背景情况:
- 肺炎 (PJP) 是一个严重的机会性感染在免疫受损的个体.
- 在诊断上,将PJP与P. jirovecii殖民 (PJC) 区分开来是具有挑战性的.
- 准确的检测对于适当的治疗和患者的结果至关重要.
研究的目的:
- 系统地评估各种测试的诊断准确性,以区分PJC和PJP.
- 为了比较定量PCR (qPCR),嵌套PCR, (1,3) -Beta-D葡萄糖 (BDG),元基因组下一代测序 (mNGS) 和数字PCR (ddPCR) 的性能.
主要方法:
- 原始临床研究的系统审查和元分析.
- 在PubMed,Embase和Web of Science进行的搜索.
- 使用QUADAS-2和PRISMA指南进行质量评估;使用随机效应或固定效应模型评估性能.
主要成果:
- 包括28项研究 (2550名患者).
- 总体聚合灵敏度为0.80,特异性为0.83.
- 下一代元基因组测序 (mNGS) 显示出最高的性能 (灵敏度为0.87,特异性为0.87),但定量PCR (qPCR) 显示出足够的灵敏度 (0.78) 和高特异性 (0.83).
结论:
- 定量PCR (qPCR) 仍然是区分P. jirovecii感染与殖民的有价值工具.
- (1,3) -Beta-D葡萄糖 (BDG) 具有较低的特异性,而mNGS在非标准化解释方面是昂贵的.
- 需要进一步进行精心设计的随机临床试验,以标准化qPCR协议,以便进行可靠的临床诊断.
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