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目的 评估GeneXpert MTB/RIF检测在HIV感染者中诊断结核病的临床价值.方法 检索PubMed、《西文生物医学期刊文献数据库》(Foreign Medical Journal Service,简称FMJS)、考克兰图书馆(The Cochrane Library)、中国知网、万方数据库、维普数据库等,收集GeneXpert MTB/RIF检测在HIV感染患者中诊断结核病的文献,检索起止时间均为建库至2016年3月.初步检索到相关文献170篇.对纳入文献进行资料提取和质量评价,采用评价诊断准确性质量研究工具(quality assessment of diagnostic accuracy studies,QUADAS)量表进行文献质量评价,使用Meta-Disc 1.4软件和Stata 12.0软件进行Meta分析.结果 共纳入10篇文献,涉及到6个国家,包含了来自临床的1878例患者的检测标本.Meta分析结果显示,GcncXpert MTB/RIF在HIV感染者中诊断结核病的汇总敏感度为69％(95％CI:65％～72％),汇总特异度为97％(95％CI:95％～98％),汇总受试者工作特征(summary receiver operating characteristics,SROC)曲线下面积(area under the curve,AUC)为98％.按照收集到的标本类型进行亚组分析,GeneXpert MTB/RIF在呼吸道标本中诊断结核病的汇总敏感度及特异度分别为76％ (95 ％CI:71％～80％)和98％(95％ CI:97％～99％),明显高于非呼吸道标本的62％(95％CI:57％～67％)和94％(95％CI:91％～96％).其中6项研究比较了GeneXpert MTB/RIF与痰涂片抗酸染色镜检的诊断效能,发现其敏感度[69％ (95％ CI:65％～72％)]高于痰涂片抗酸染色[53％ (95％ CI:47％～58％)].结论 GeneXpert MTB/RIF检测在HIV感染者中诊断结核病的临床价值较高,其对呼吸道标本的诊断效能明显高于非呼吸道标本,并且其敏感度高于痰涂片抗酸染色镜检.“,”Objective To evaluate the clinical value of GeneXpert MTB/RIF assay in diagnosis of tuberculosis in HIV-infection patients.Methods Studies about the value of GeneXpert MTB/RIF assay in diagnosis of tuberculosis in HIV infected patients were searched in PubMed,Foreign Medical Journal Service (FMJS),the Cochrane Library,China National Knowledge Infrastructure (CNKI),Wanfang data base and VIP Journal Integration Plaform (VIJP),etc.,from establishment to March 2016.A total of 170 relevant documents were preliminary retrieved and were assessd using quality assessment of diagnostic accuracy studies (QUADAS) Meta-Disc 1.4 software and Stata 12.0 software were used for Meta analysis.Results A total of 10 studies from six different countries were recruited in the analysis,including 1878 specimens from clinical patients.Meta-analysis showed that the pooled sensitivity and specificity of GeneXpert MTB/RIF test for the diagnosis of tuberculosis among patients with HIV infection were 69％ (95％CI:65％-72％) and 97％ (95％CI:95％-98％),respectively;and the area under the curve (AUC) of summary receiver operating characteristics (SROC) was 98％.According to different types of specimens collected from the subgroup analysis,GeneXpert MTB/RIF test pooled sensitivity and specificity for diagnosis tuberculosis in respiratory specimens were significantly higher than those in non-respiratory specimens (76％ (95％CI:71％-80％) vs.62％ (95％CI:57％-67％) and 98％ (95％CI:97％-99％) vs.94％ (95％％CI:91％-96 ％)).Six studies compared the GeneXpert MTB/RIF diagnostic performance with sputum smear acid-fast staining microscopic examination in HIV infected patients and found that the sensitivity (69％ (95％CI:65％-72 ％)) was higher than sputum smear acid-fast staining microscopic examination (53 ％ (95 ％ CI:47 ％-58 ％)).Conclusion GeneXpert MTB/RIF test was of high clinical value in diagnosis of tuberculosis in HIV-infected patients.It was more sensitive and specific in respiratory specimens than in non-respiratory specimens,and the differences were statistical.Furthermore,the sensitivity of GeneXpert MTB/RIF test was higher than sputum smear acid-fast staining microscopic examination.