Comparison between sputum induction and self-expectoration samples in the positive detection rates of Mycobacterium tuberculosis based on mete-analyses

Abstract

Abstract: Objective To explore whether the use of induced sputum technique has an advantage over self-expectoration on the positive detection rate of Mycobacterium tuberculosis through sputum smears,molecular biology techniques and sputum culture methods in tuberculosis（TB） patients through meta-analysis. Methods Retrieve relevant literature published since the establishment of the database until January 2024 from China National Knowledge Infrastructure（CNKI） Database,Wanfang Database,China Science and Technology Journal Database,Pubmed,Cochrane Library,and Embase Database. Two researchers selected appropriate studies according to the established inclusion and exclusion criteria. Meta-analysis was performed with R 4.3 and Stata 14.0 software, and fixed-effects model was used to estimate the overall odds ratio（OR） and its 95%CI. The Newcastle-Ottawa Scale（NOS） was used to assess the quality of the included literature,and meta-analysis results were presented in forest plots,drapery plot,sensitivity analysis,and subgroup analysis. Publication bias was corrected by Egger's linear regression,Begg's rank correlation test,and contour-enhanced funnel plots. Results A total of 528 articles were retrieved,among which 11 literatures met the inclusion criteria. All of the studies were conducted in high TB burden countries. The number of eligible samples obtained was 3 575 for sputum induction and 3 407 for self-expectoration,and the success rate of sputum induction ranged from 78.90% to 100.00%. Meta-analysis results showed that the positive detection rate of Mycobacterium tuberculosis in pulmonary tuberculosis patients detected by sputum induction technique was 1.87 times higher than that of self-expectoration technique（95%CI：1.66-2.09,P<0.01）,and there was no heterogeneity among included studies（I²=0,P>0.05）. Subgroup analysis by clinical diagnostic classification,sample testing method,pretreatment of sputum,saline concentration,and induction duration showed consistent results with the overall results. Egger's linear regression（t=2.767,P<0.05） and Begg's rank correlation test（Z=2.352,P<0.05） showed publication bias,and the original results were considered reliable after correcting for publication bias through trim and fill method. Conclusion Compared with self-expectoration,the induced sputum technique can improve the positive detection rate of sputum samples from TB patients,and is a safe,convenient and cost-effective method of operation.

Key words: Sputum induction, Mycobacterium tuberculosis, Pulmonary tuberculosis, Meta-analysis, Drapery plot

ZHANG Xiaoyi, HAN Feng, ZHANG Zhe. Comparison between sputum induction and self-expectoration samples in the positive detection rates of Mycobacterium tuberculosis based on mete-analyses. [J]OCCUPATION AND HEALTH, 2025, 41(11): 1545-1551.

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