Diagnostic accuracy of TB-LAMP for pulmonary tuberculosis: a systematic review and meta-analysis

被引:46
作者
Shete, Priya B. [1 ,2 ,3 ]
Farr, Katherine [1 ,2 ,3 ]
Strnad, Luke [4 ]
Gray, Christen M. [5 ]
Cattamanchi, Adithya [1 ,2 ,3 ]
机构
[1] Univ Calif San Francisco, Div Pulm & Crit Care Med, 1001 Potrero Ave,5K1, San Francisco, CA 94110 USA
[2] Zuckerberg San Francisco Gen Hosp, 1001 Potrero Ave,5K1, San Francisco, CA 94110 USA
[3] Univ Calif San Francisco, Curry Int TB Ctr, San Francisco, CA 94143 USA
[4] Oregon Hlth & Sci Univ, Div Infect Dis, 3188 SW Sam Jackson Pk Rd,Mail Code L457, Portland, OR 97239 USA
[5] London Sch Hyg & Trop Med, Fac Epidemiol & Populat Hlth, Room G30,Keppel St, London WC1E 7HT, England
关键词
Tuberculosis; Diagnostic testing; Molecular assay; Point of care; MEDIATED ISOTHERMAL AMPLIFICATION; MYCOBACTERIUM-TUBERCULOSIS;
D O I
10.1186/s12879-019-3881-y
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
BackgroundThe need for a rapid, molecular test to diagnose tuberculosis (TB) has prompted exploration of TB-LAMP (Eiken; Tokyo, Japan) for use in resource-limited settings. We conducted a systematic review to assess the accuracy of TB-LAMP as a diagnostic test for pulmonary TB.MethodsWe analyzed individual-level data for eligible patients from all studies of TB-LAMP conducted between Jan 2012 and October 2015 to compare the diagnostic accuracy of TB-LAMP with that of smear microscopy and Xpert MTB/RIF (R) using 3 reference standards of varying stringency. Pooled sensitivity and specificity and pooled differences in sensitivity and specificity were estimated using random effects meta-analysis. Study quality was evaluated using QUADAS-2.ResultsFour thousand seven hundred sixty individuals across 13 studies met eligibility criteria. Methodological quality was judged to be low for all studies. TB-LAMP had higher sensitivity than sputum smear microscopy (pooled sensitivity difference+132, 95% CI 45-219%) and similar sensitivity to Xpert MTB/RIF (pooled sensitivity difference-25, 95% CI -80 to +29) using the most stringent reference standard available. Specificity of TB-LAMP was similar to that of sputum smear microscopy (pooled specificity difference-18, 95% CI -38 to +02) and Xpert MTB/RIF (pooled specificity difference 05, 95% CI -09 to +18).ConclusionsFrom the perspective of diagnostic accuracy, TB-LAMP may be considered as an alternative test for sputum smear microscopy. Additional factors such as cost, feasibility, and acceptability in settings that continue to rely on sputum smear microscopy should be considered when deciding to adopt this technology. Xpert MTB/RIF should continue to be preferred in settings where resource and infrastructure requirements are adequate and where HIV co-infection or drug-resistance is of concern.
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页数:11
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