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中国循证儿科杂志

中国循证儿科杂志 ›› 2016, Vol. 11 ›› Issue (3): 187-194.

• 论著 • 上一篇    下一篇

支气管镜介导标本对儿童结核病诊断价值的系统评价和Meta分析

付文龙1,2，张娟娟1，代继宏2   

  1. 重庆医科大学附属儿童医院 1 儿童发育与疾病教育部重点实验室，2 呼吸中心 重庆，401104
  • 收稿日期:2016-03-18 修回日期:2016-06-25 出版日期:2016-06-25 发布日期:2016-06-25
  • 通讯作者: 代继宏

Diagnostic value of specimens via bronchoscopy for tuberculosis in children: a systematic review and meta-analysis

FU Wen-long1,2, ZHANG Juan-Juan1, DAI Ji-hong2   

  1. 1 Key Laboratory of Developmental Diseases in Childhood, Ministry of Education, 2 Center of Respiratory Disorders of Children′s Hospital, Chongqing Medical University, Chongqing 400014, China
  • Received:2016-03-18 Revised:2016-06-25 Online:2016-06-25 Published:2016-06-25
  • Contact: DAI Ji-hong

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摘要：

目的 定量评估支气管镜介导标本对儿童结核病（TB）的诊断价值。方法 检索PubMed、EMBASE、Ovid、Cochrane图书馆、中国生物医学文献数据库、中国知网和万方数据库，检索起止时间为建库至2016年2月，并回溯纳入文献的参考文献。2名研究者根据纳入与排除标准筛选文献,采用QUADAS-2量表行文献偏倚风险评估。以临床诊断和实验室诊断作为TB诊断的金标准，评估支气管镜介导标本（支气管肺泡灌洗液、支气管黏膜组织及支气管黏膜刷检）及不同检测方法诊断儿童TB的敏感度和特异度，并以胃液作为对照标本。采用Meta-Disc 1.4软件进行Meta分析，建立汇总受试者工作特征（SROC）曲线，并计算曲线下面积 (AUC)等。采用Stata 12.0软件绘制Deek′s漏斗图评估发表偏倚。结果 14篇文献进入Meta分析，纳入2 781份（1 082例患儿）的支气管镜介导标本。①14篇文献报道了支气管镜介导所有标本对儿童TB的诊断，汇总敏感度和特异度分别为0.38（95%CI：0.35～0.41）和1.00（95%CI：0.99～1.00）；按照标本及检测方法行亚组分析，支气管黏膜组织活检的敏感度为0.51（95%CI：0.40～0.61），特异度为1.00（95%CI：0.81～1.00）；支气管肺泡灌洗液培养、涂片和PCR的敏感度分别为0.36（95%CI：0.32～0.40）、0.21（95%CI：0.15～0.28）和0.58（95%CI：0.46～0.69），特异度分别为1.00（95%CI：0.99～1.00）、1.00（95%CI：0.98～1.00）和1.00（95%CI：0.84～1.00）。②10篇文献报道胃液对儿童TB的诊断，胃液培养敏感度为0.52（95%CI：0.47～0.57），特异度为1.00（95%CI：0.98～1.00）；涂片敏感度为0.25（95%CI：0.16～0.36），特异度为1.00（95%CI：0.95～1.00）。③支气管肺泡灌洗液所有检测方法诊断TB的SROC AUC为0.883 9；胃液所有检测方法诊断TB的SROC AUC为0.873 7。④支气管肺泡灌洗液培养、涂片和胃液诊断TB文献的Deeks′检验P分别为0.005、0.014和0.147。结论 支气管镜介导的标本对儿童TB的诊断价值是肯定的，但支气管肺泡灌洗液作为最常用的标本采用培养和涂片对TB诊断的敏感度不优于胃液。

Abstract:

Objective To systematically evaluate the diagnostic value of specimens via bronchoscopy for tuberculosis(TB) detection in children.Methods The PubMed，EMBASE, Ovid, Cochrane Library, CBM, CNKI and Wanfang database were systematically searched up to February 2016, and relevant references were manual screened. Two reviewers independently screened literatures according to the inclusion and exclusion criteria and extracted data, and assessed the risk of bias of included studies by QUADAS-2 tool. The sensitivity and specificity of test methods and specimens (bronchoalveolar lavage, bronchial brushing and tissue biopsy) via bronchoscopy were evaluated by gold standard(clinical and laboratory diagnosis). Meta-analysis was performed using Meta-Disc 1.4 software, and summary receiver operating characteristic curve (SROC) was drawn and area under the curve (AUC) and Q index were calculated. Deek′s funnel plots were drawn using Stata 12.0 software.Results A total of 14 studies were included involving 2 781 specimens (1 082 patients). ①Fourteen literatures reported bronchoscopy for the diagnosis of TB. The pooled sensitivity and specificity of bronchoscopy for tuberculosis detection were 0.38（95%CI：0.35-0.41）and 1.00（95%CI：0.99-1.00）, respectively. Then subgroup analysis was made by the types of specimens and test methods. The pooled sensitivity and specificity of tissue biopsy were 0.51（95%CI：0.40-0.61）and 1.00（95%CI：0.81-1.00） , respectively; The pooled sensitivity and specificity of culture, acid fast bacilli on smear and PCR for bronchoalveolar lavage were 0.36（95%CI：0.32-0.40）vs 1.00（95%CI：0.99-1.00）, 0.21（95%CI：0.15-0.28）vs 1.00（95%：0.98-1.00）and 0.58（95%CI：0.46-0.69）vs 1.00（95%CI：0.84-1.00）, respectively. ②Ten literatures reported gastric lavage for the diagnosis of tuberculosis, which exhibited heterogeneity（P<0.001,I2=93.3%）. The pooled sensitivity and specificity of gastric lavage for tuberculosis detection were 0.45（95%CI：0.40-0.49）and 1.00(95%CI：0.99-1.00), respectively. The pooled sensitivity and specificity of smear for gastric lavage were 0.52（95%CI：0.47-0.57）and 1.00（95%CI：0.98-1.00）, respectively. ③The SROC AUC of bronchoalveolar lavage and gastric lavage were 0.883 9 and 0.873 7, respectively; ④P values of the Deek′s test of culture and smear for bronchoalveolar lavage were 0.005 and 0.014. P value of the Deek′s test of gastric lavage was 0.147.Conclusion The value of bronchoscopy for the diagnosis of tuberculosis was definitive in children. Bronchoalveolar lavage for bronchoscopy was the most common specimen, but in terms of culture and smear, it wasn′t better than gastric lavage for tuberculosis detection.

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