γ干扰素释放试验对成人活动性结核病诊断价值的荟萃分析

Gamma interferon release test for adult active tuberculosis diagnosis value of Meta-analysis

目的以结核菌素皮肤试验(TST)为参照标准,评价γ干扰素释放试验(IGRAs)对活动性结核病的诊断价值。方法计算机检索Pubmed、Medline、Web of Science、Cochrane Library、EBSCO、Elsevier、中国知网数据库、万方数据、中国生物医学文献数据库等数据库,检索时间为建库至2017年5月。根据文献质量评价QUADAS条目量表评价入选文献质量,采用Stata 12.0软件进行Meta分析,检验异质性,评估入选文献发表性偏倚。结果初检得到相关文献871篇,依据文献纳入和排除标准,最终入选文献10篇(6篇文献采用T-SPOT.TB方法,7篇采用QFT-GIT方法),共涉及活动性结核病患者746例,非活动性结核患者806例。以TST作为参照标准,T-SPOT.TB试验和QFT-GIT试验对活动性结核病诊断价值的汇总敏感性、汇总特异性、汇总阳性似然比、汇总阴性似然比、汇总诊断比值比、汇总受试者工作特征曲线下面积分别为81%、67%、2.42、0.29、8.57、0.82和87%、68%、2.71、0.20、13.72、0.87。结论目前证据表明,IGRAS试验对于成人活动性结核病的诊断效能和对非活动性结核病的鉴别能力虽均明显优于TST,但总体诊断实力中等,对于IGRAS试验阴性结果可基本排除活动性结核病的可能。

Objective To evaluate the diagnostic value of IGRAs for active tuberculosis as a reference standard for tuberculin skin test （TST）. Methods The PubMed, Medline, Web of Science, the Cochrane Library, EBSCO, Elsevier, Chinese Knowledge Network Database, Wanfang Data, the Chinese Biomedical Literature Database were searched, from the building up to May 2017. The quality of selected doc＇uments was evaluated by the QUADAS item scale. Stata 12.0 software was used for Meta arialysis to test heterogeneity and to evaluate the publication bias of the selected literature. Results At the.beginning of the examination, 871 related articles were collected. According to the inclusion and exclusion criteria of the literature, 10 urticles were selected （6 articles adopted the T - SPOT. TB method, and 7 articles adopted QFT - GIT method）, including 746 pa- tients with active tuberculosis, 806 patients with inactive tuberculosis. TST as reference standard, T SPOT. TB test and QFT - GIT test summary of the value of active TB diagnosis sensitivity, summarizing specificity, summary positive likeiihood ratio, and-summarize the negative likelihood ratio, and summarize diagnostic odds ratio, aggregate area under the receiver-operating characteristic curve were respectively 81%, 67%, 2.42, 0.29, 8.57, 0.82 and 87%, 68%, 2.71, 0.20, 13.72, 0.20. Conclusion Present evidence indicates that IGRAs test is significantly better than TST for the diagnostic efficacy of active tuberculosis in adults and the differential ability of non-active TB, but the overall diagnostic strength is moderate, and the negative results of the IGRAs test can largely exclude the possibility of active tuberculosis.