γ-干扰素释放试验诊断结核分枝杆菌感染相关研究meta分析

Interferon-γ Release Assay in Diagnosis of Tuberculosis Infection: a Meta-analysis

目的评价γ-干扰素释放试验（interferon-γrelease assays,IGRA）在结核分枝杆菌感染诊断中的应用价值。方法通过计算机检索中国生物医学文献数据库（CBM）、中国知网（CNKI）和万方数据库（1994年1月—2013年6月）获得IGRA诊断结核分枝杆菌感染的诊断性试验研究的中文文献。由两名研究者按照相同的检索策略独立进行文献筛选和数据提取,排除不符合纳入标准的文献后,应用Meta Disc 1.4软件进行数据分析。结果本研究共检索到符合要求的文献17项,共1799例结核患者和885例对照者纳入meta分析。结果显示IGRA诊断结核分枝杆菌感染敏感度为86%[95%可信区间（CI）：0.85-0.88],特异度为86%（95%CI：0.83-0.88）;阳性似然比为6.06（95%CI：4.76-7.70）,阴性似然比为0.12（95%CI：0.09-0.18）,诊断比数比为58.67（95%CI：35.37-97.31）。拟合SROC曲线下面积（area under the curve,AUC）为0.9457,Q＊=0.8848。结论 IGRA诊断结核分枝杆菌感染有较高的敏感性和特异性,可作为临床快速诊断结核病的有效方法。

Objective To evaluate the application value of interferon-γ release assays（ IGRA） in diagnosis of mycobacterium tuberculosis infection. Methods All Chinese studies about IGRA in diagnosis of mycobacterium tuberculosis infection during January 1994 and June 2013 were retrieved from CbmWin,CNKI and Wanfang databases. Two researchers achieved studies screening and data fetch independently,and then data analysis were conducted by meta-Disc1. 4 software after discrepancy studies were removed. Results Seventeen studies with 1799 patients and 885 controls were included in this study. The results of meta-analysis showed that the sensitivity of mycobacterium tuberculosis was 86% [95% confidence interval（ CI） ： 0.85-0.88]; specificity was 86%（ 95% CI： 0.83-0.88）; positive likelihood ratio（ LR） was 6.06（ 95% CI：4. 76- 7. 70）; negative LR was 0. 12（ 95% CI： 0. 09- 0. 18） and diagnosis odds ratio（ DOR） was 58. 67（ 95% CI：35. 37- 97. 31）. Area under the curve（ AUC） of fitting the summary receiver operating characteristic（ SROC） was 0. 9457and Q＊= 0. 8848. Conclusion Whole-blood interferon-γ release assays has good sensitivity and specificity in diagnosis of mycobacterium tuberculosis infection,and can be used as an effective method in clinical diagnosis of TB.