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임신 여성에서 B군 사슬알균 검사[실시간 중합효소연쇄반응법]의 진단정확성과 검출률: 체계적 문헌고찰과 메타분석

Diagnostic Accuracy and Detection Rate of Real-Time PCR for Detection of Group B Streptococcal Colonization in Pregnant Women: Systemic Review of Literature and Meta-Analysis

김석현|김소영|최원정|홍성근|박선영
대한임상미생물학회 (Korean Society of Clinical Microbiology)|2017.06|Annals of Clinical Microbiology|제20권 제2호|pp. 42-51

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Pregnant womenReal-time polymerase chain reactionStreptococcus agalactiaeGroup B streptococcus

초록

배경: B군 사슬알균(Group B streptococcus, GBS)은 신생아의 감염과 사망의 주요 원인균이다. 미국의 질병예방통제센터는 GBS의 수직감염을 예방하기 위하여 35-37주 임산부를 대상으로 배양, 라텍스 응집법(latex agglutination test) 또는 핵산 증폭 검사(nucleic acid amplification test)와 같은 검사법을 이용하여 GBS의 집락화 여부를 확인하고, 필요시 항균제를 사용하도록 권고하고 있다. 본 연구에서는 임신한 여성을 대상으로 GBS 검출을 위한 실시간 중합효소연쇄반응법(real-time polymerase chain reaction)의 진단정확성과 검출률을 조사하여 임상적 유효성을 확인하였다. 방법: 문헌검색은 KoreaMed, Ovid-MEDLINE, Ovid-EMBASE, Cochrane Library의 데이터베이스를 이용하여 2015년 11월 3일에 이루어졌다. 검색전략에 따라 ‘Group B Streptococcus’, ‘real time polymerase chain reaction’ 등의 단어로 검색하고, 수기검색된 2편을 포함하여 총 443편의 문헌이 확인되었다. 두 명의 연구자가 독립적으로 문헌을 선택하였으며, Scottish Intercollegiate Guidelines Network의 방법론적 체크리스트를 사용하여 문헌의 질을 확인하였다. 결과: 선택된 총 34편의 문헌에서 실시간 중합효소연쇄반응법의 진단정확성에 대한 메타분석이 수행되었다(실시간 중합효소연쇄반응법: 13,516건, 배양검사 및 기타검사: 1,815건). 문헌에서 실시간 중합효소연쇄반응으로 확인된 임산부의 GBS 집락화율을 2.0-69.8%였다. 중재검사의 진단정확성은 통합 민감도 0.93 (95% CI 0.92-0.94, I2=86.3%), 통합 특이도 0.96 (95% CI 0.96-0.96, I2=90.2%), SROC AUC (summary receiver operating characteristic area under the curve)가 0.99로 보고되었다. 결론: 임신부를 대상으로 GBS를 검출하는 실시간 중합효소연쇄반응법은 진단정확성이 높아 신생아 수직감염을 예방하는데 있어 유효성이 있는 검사로 판단된다. [Ann Clin Microbiol 2017;20:42-51]

Abstract

Background: Group B streptococcus (Streptococcus agalactiae, GBS) was reported as a major cause of neonatal infection and death. To prevent vertical transmission, CDC recommended that all women in week 35-37 of pregnancy should receive the GBS colonization test. We conducted a systematic review and meta-analysis to evaluate diagnostic accuracy and detection rate of real-time PCR for GBS in pregnant women. Methods: The literature review for GBS using real-time PCR was done including KoreaMed, Ovid- MEDLINE, Ovid-EMBASE, and Cochrane Library on November 3, 2015. 443 articles were collected. Two authors select articles and evaluated the quality of studies using Scottish Intercollegiate Guidelines Network tool independently. Results: Diagnostic accuracy of the real-time PCR was assessed by meta-analysis through 34 articles (13,516 for real-time PCR, 1,815 for culture and other comparison test). The GBS colonization was assessed through 34 articles, which reported varying values of 2.0-69.2% using real-time PCR. The real-time PCR for GBS was shown to have overall sensitivity of 0.93 (95% CI 0.92-0.94, I2=86.3%), overall specificity of 0.96 (95% CI 0.96-0.96, I2= 90.2%), SROC AUC of 0.99. Conclusion: Real-time PCR is an effective test for detecting GBS colonization in pregnant women, resulted in preventing the infection in a new born baby. (Ann Clin Microbiol 2017;20:-51)

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관련 논문AI추천

산모에서 발색배지와 중합효소연쇄반응을 이용한 B군 사슬알균의 신속한 검출김선주, 신효심, 이동현대한임상미생물학회 · Annals of Clinical Microbiology2017 · 제20권 제4호Usefulness of a Rapid Real-time PCR Assay in Prenatal Screening for Group B Streptococcus Colonization김영문, 김의종, 박성섭, 박정수, 성문우, 신손문, 양재혁, 조동희대한진단검사의학회 · Annals of Laboratory Medicine2013 · 제33권 제1호Prevalence of group B streptococcus colonization in pregnant women in a tertiary care center in Korea김기태, 김다현, 김영남, 민병진, 변정미, 성문수, 이경복, 정대훈, 정은정대한산부인과학회 · Obstetrics & Gynecology Science2018 · 제61권 제5호A Retrospective National Study on Colonization Rate and Antimicrobial Susceptibility of Streptococcus agalactiae in Pregnant Korean Women, 2018–2020어영, 김영진, 배혜경, 이경렬, 이경원, 최성진, 홍정미연세대학교의과대학 · Yonsei Medical Journal2022 · 제63권 제8호Recent Epidemiological Changes in Group B Streptococcus Among Pregnant Korean Women강지은, 최성진, Uh Young대한진단검사의학회 · Annals of Laboratory Medicine2021 · 제41권 제4호우리나라 임신부에서의 B군 사슬알균의집락화에 대한 연구강병희, 김민우, 김상현, 김영아, 이종표, 장두영, 장현오, 조종래, 최형민, 황경진대한산부인과학회 · Obstetrics & Gynecology Science2006 · 제49권 제2호

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