中文摘要：

目的 评估Xpert结核分枝杆菌/利福平（MTB/RIF）试验对结核病的诊断价值.方法 检索PubMed、Medline、中国知网、万方数据库等,收集Xpert MTB/RIF试验对结核病诊断价值的文献,检索起止时间均为建库至2012年6月.2名研究者独立进行资料提取和文献质量评估.采用Meta-Disc 1.4软件进行Meta分析.结果 共纳入26篇文献,其中2篇文献涉及儿童病例,包含了13 270例来自临床患者的检测标本.Meta分析结果显示,Xpert MTB/RIF试验诊断结核病的汇总敏感度为87%（95%CI：86%～88%）、特异度为97%（95%CI：97%～97%）.按照结核病的类型和患者年龄进行亚组分析,Xpert MTB/RIF试验诊断肺结核的敏感度高于肺外结核病,90%（95%CI：89%～91%） vs 76%（95%CI：72%～79%）;诊断涂阴菌阳性和涂阳菌阳性结核病的敏感度分别为74%（95%CI：71%～76%）和99%（95%CI：98%～99%）;对儿童肺结核的诊断敏感度比成人肺结核低,74%（95%CI：65%～83%） vs 90%（95%CI：89%～92%）.Xpert MTB/RIF试验诊断耐多药结核病的敏感度为96%（95%CI：94%～97%）,特异度为98%（95%CI：98%～99%）.结论 Xpert MTB/RIF试验诊断结核病的价值较高,尤其是成人结核病及耐多药结核病.Xpert MTB/RIF试验在儿童结核病中的诊断价值由于纳入文献较少,尚待进一步研究.

英文摘要：

Objective To evaluate the diagnostic value of Xpert MTB/RIF assay to tuberculosis systematically. Methods Studies about the diagnostic value of Xpert MTB/RIF assay to tuberculosis were searched in PubMed, Medline, CNKI and Wangfang database from establishment to June 2012. Two researchers fetched the data from included studies independently, and then Meta-Disc software（ version 1.4）was used for meta-analysis. Results A total of 26 studies were recruited in the analysis, including 13 270 sediments from clinical patients. In all kinds of tuberculosis, the pooled sensitivity and specificity of Xpert MTB/ RIF were 87% （95% CI：86% - 88% ） and 97% （95% CI：97% - 97% ） respectively. Then subgroup analysis was made by the types of tuberculosis and the patients＇ age, showing that Xpert MTB/RIF assay was more sensitive in diagnosing pulmonary tuberculosis than in extrapulmonary tuberculosis, and in smear-negative tuberculosis. The pooled sensitivity of Xpert MTB/RIF assay reached 74% （95% CI： 71% -76% ）, and the sensitivity in diagnosing pediatric tuberculosis was lower than adult tuberculosis. In multi-drug resistant tuberculosis, the pooled sensitivity and specificity were 96% （95% CI：94% -97% ）and 98% （95%CI：98% -99%）, respectively. Conclusions The diagnostic value of Xpert MTB/RIF assay to tuberculosis was very high, especially in adult tuberculosis. Because studies on pediatric tuberculosis were very few, the diagnostic value of Xpert MTB/RIF assay to pediatric tuberculosis should be confirmed by performing prospective cohort studies further.