commercial nucleic-acid amplification tests for diagnosis of pulmonary tuberculosis in respiratory specimens meta-analysis and meta-regression商业核酸扩增检测诊断肺结核的呼吸道标本荟萃分析和多元回归.pdfVIP

Commercial Nucleic-Acid Amplification Tests for Diagnosis of Pulmonary Tuberculosis in Respiratory Specimens: Meta-Analysis and Meta-Regression 1 2 1,3 4 Daphne I. Ling , Laura L. Flores , Lee W. Riley , Madhukar Pai * 1 Division of Epidemiology, School of Public Health, University of California, Berkeley, California, United States of America, 2 Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, San Francisco, California, United States of America, 3 Division of Infectious Diseases, School of Public Health, University of California, Berkeley, California, United States of America, 4 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada Background. Hundreds of studies have evaluated the diagnostic accuracy of nucleic-acid amplification tests (NAATs) for tuberculosis (TB). Commercial tests have been shown to give more consistent results than in-house assays. Previous meta- analyses have found high specificity but low and highly variable estimates of sensitivity. However, reasons for variability in study results have not been adequately explored. We performed a meta-analysis on the accuracy of commercial NAATs to diagnose pulmonary TB and meta-regression to identify factors that are associated with higher accuracy. Methodology/ Principal Findings. We identified 2948 citations from searching the literature. We found 402 articles that met our eligibility criteria. In the final analysis, 125 separate studies from 105 articles that reported NAAT results from respiratory specimens were included. The pooled sensitivity was 0.85 (range 0.36–1.00) and the pooled specificity was 0.97 (range 0.54–1.00). However, both measures were significantly heterogeneous (p,.001). We performed subgroup and meta-regression analyses to identify sources o