干扰素γ诱导蛋白10对结核诊断价值的meta分析

Diagnosis accuracy of interferon gamma induced protein 10 in tuberculosis： a meta-analysis

目的系统评价干扰素γ诱导蛋白10（IP—10）对结核的诊断价值并作meta分析。方法计算机检索CNKI、万方、维普、Medline、Embase、CochraneLibrary等数据库，检索时间为建库至2012年7月，筛选有关IP-10对结核患者诊断价值的文献。对纳入的文献，采用QuADAs进行质量评价，MetaDisc1．4NStata软件进行定量评价及综合评估。结果共纳入12篇文献（含15项研究）。IP-10对结核的诊断价值为：合并敏感度0．81（95％CI：0．79～0．84），合并特异度0．75（95％CI：0．72～0．78），合并阳性似然比4．28（95％CI：2．59～7．06），合并阴性似然比0．25（95％CI：0．19～0．34），合并诊断优势比20．27（95％CI：9．91～41．44），SROC曲线下面积0．89。本研究还对不同检测样本、结核感染后不同临床状态进行了亚组分析，发现胸水样本中IP-10水平对结核诊断的准确性（敏感度0．86，特异度0．83）高于血液样本（敏感度0．79，特异度0．74）；IP-10诊断活动性结核的敏感度（0．86）高于对潜伏性结核的诊断（O．68）。结论：P-10对结核有一定的诊断价值，在结核感染合并胸水、活动性结核感染的患者中具有更高的临床参考价值，并且联合干扰素γ、结核菌素皮肤试验等检查可提高其诊断效能。

Objective To evaluate the accuracy of interferon gamma induced protein 10 （IP-10） measurements in the diagnosis of tuberculosis. Methods After a systematic review in CNKI, Wanfang data,Weipu data, Medline, Embase and Cochrane Library, studies about accuracy of IP-10 level in the diagnosis of tuberculosis were retrieved till July 2012 from the establishment. QUADAS was used to evaluate the quality of included studies. Quantitative evaluation and summary estimate were performed by MetaDisc 1.4 software and Stata software. Results Fifteen studies from twelve publications were included. The summary estimates for IP-10 in the diagnosis of tuberculosis were sensitivity 0.81 （95% CI ： 0. 79-0. 84）, specificity 0.75 （ 95% CI ： 0.72 - 0.78）, positive likelihood ratio 4.28 （95 % CI ： 2.59 - 7.06）, negative likelihood ratio 0. 25 （95% CI ： 0. 19 - 0. 34）, diagnostic odds ratio 20. 27 （ 95 % CI ： 9. 91 - 41.44） ,and the AUC of SROC was 0.89. Sub-group analysis suggested that the diagnostic accuracy of IP 10 in pleural fluid （sensitivity 0.86 ,specificity 0.83） was higher than that in blood sample （sensitivity 0.79,specificity 0.74）,the sensitivity of IP-10 in diagnosing active tuberculosis （0.86） was higher than that in latent tuberculosis （0.68）. Conclusions IP-10 plays a valuable role in the diagnosis of tuberculosis, especially for tuberculosis patients with pleural fluid and patients with active tuberculosis, the results of IP-10 measurements should be interpreted in parallel with other tests, such as interferon gamma, tuberculin skin test.