基于宿主的基因表达诊断在患有肺外结核的儿童的诊断性能:系统性审查
Margaret C Siu1, Maria Selinopoulou1, Susan Abarca Salazar2,3
1From the Faculty of Medicine and Dentistry, Queen Mary University of London.
The Pediatric infectious disease journal
|September 24, 2025
概括
在儿童中诊断肺外结核 (EPTB) 很困难. 主体基因表达测试显示出有希望的结果,但目前的证据有限,准确性不符合世卫组织对儿科EPTB的目标.
科学领域:
- 儿童传染病 儿童传染病
- 分子诊断学 分子诊断
- 结核病研究 结核病研究
背景情况:
- 在儿童中诊断肺外结核 (EPTB) 存在重大挑战,原因是非特异性症状和传统微生物学测试的低产量.
- 主体基因表达特征正在被探索为EPTB的非唾液基础的诊断方法.
- 本系统性审查评估了这些基因表达特征在儿科EPTB病例中的诊断性能.
研究的目的:
- 系统地审查和评估宿主基因表达特征的诊断性能,以识别儿童肺外结核 (EPTB).
- 评估当前关于这些新型诊断方法的准确性和局限性的证据基础.
主要方法:
- 从1965年1月到2025年5月,在PubMed,Embase和Cochrane图书馆数据库中进行了系统的文献搜索.
- 包括专注于患有EPTB的儿童 (0-18岁) 的研究,但不包括仅针对成人,混合肺/EPTB或仅针对肺结核的研究.
- 数据提取和选由两名独立审查员进行,以确保数据质量和解决差异.
主要成果:
- 只有两项研究符合纳入标准,涉及15岁以下的891名来自低收入和中等收入国家的儿童.
- 一项研究的3基因MTB-HR原型显示59.8%的灵敏度 (培养确认) 和50.0%的灵敏度 (隔离EPTB).
- 另一项研究的miRNA-29a试验在不同样本类型 (血液,脑脊髓液) 中显示出不同的灵敏度和特异性,并指出存在偏差的高风险.
结论:
- 目前对儿科EPTB宿主基因表达诊断的证据稀少,以有限数量的研究和小样本大小为特征.
- 显著的局限性包括潜在的偏见,缺乏分类数据,以及目前低于世界卫生组织目标的诊断准确性.
- 为了验证这些有前途的诊断工具,需要使用强大的方法和更大,更多样化的队列进行进一步的研究.
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