胸腔积液γ-干扰素释放试验对结核性胸腔积液诊断价值的Meta分析

Role of pleural effusion interferon-gamma release assay for the diagnosis of tuberculous pleural effusion:a Meta analysis

目的评价胸腔积液γ-干扰素释放试验(IGRA)对结核性胸腔积液的诊断价值。方法使用计算机检索PubMed、EMbase、Medline、The Cochrane Library(2015年第6期)、中国知网、万方数据和维普网,全面收集胸腔积液IGRA诊断结核性胸腔积液的相关研究,检索时限均为建库至2016年7月1日。由2位评价员独立筛选文献、提取资料和评价纳入研究的方法学,采用Meta-Disc 1.4软件进行Meta分析。计算合并敏感性、合并特异性、合并阳性似然比、合并阴性似然比、合并诊断优势比,绘制汇总受试者工作特征(SROC)曲线并计算曲线下面积(AUC)。结果最终纳入27项研究,共涉及胸腔积液患者2 072例。胸腔积液IGRA诊断结核性胸腔积液的合并敏感性、合并特异性、合并阳性似然比、合并阴性似然比、合并诊断优势比、AUC分别为0.85[95%可信区间(CI)0.83~0.87)]、0.85(95%CI 0.83~0.88)、5.37(95%CI 3.38~8.53)、0.16(95%CI 0.09~0.26)、41.31(95%CI 17.48~97.61)、0.930 0。结论胸腔积液IGRA对结核性胸腔积液具有较高的诊断价值。

Objective To evaluate the role of pleural effusion interferon-gamma release assay（IGRA） for the diagnosis of tuberculous pleural effusion. Methods Databases included PubMed,EMbase,Medline,the Cochrane Library（Issue 6,2015）,CNKI,WanFang Data and VIP,and related literature was searched from inception to July 1st,2016. Two reviewers screened literature according to the inclusion and exclusion criteria,extracted related data and assessed. Meta-Disc 1.4 software was used to perform Meta analysis. Pooled sensitivity,pooled speci？city,pooled positive likelihood ratio,pooled negative likelihood ratio,pooled diagnostic odds ratio and area under curve（AUC） of summary receiver operating characteristic（SROC）curve was used to assess the diagnosis ef？ciency. Results A total of 27 studies involving 2 072 patients with pleural effusion were included. The pooled sensitivity,pooled speci？city,pooled positive likelihood ratio,pooled negative likelihood ratio,pooled diagnostic odds ratio and the AUC of SROC curve were 0.85 [95% con？dence interval（CI）0.83-0.87],0.85（95% CI 0.83-0.88）, 5.37（95% CI 3.38-8.53）,0.16（95% CI 0.09-0.26） and 41.31（95% CI 17.48-97.61） and 0.930 0,respectively. Conclusions Pleural effusion IGRA plays a role for the diagnosis of tuberculous pleural effusion.