干扰素-γ释放试验在结核病中的系统评价：重点关注似然比。
Systematic review of interferon-gamma release assays in tuberculosis: focus on likelihood ratios.
机构信息
Tuberculosis and Chest Service, Department of Health, Hong Kong SAR, China.
出版信息
Thorax. 2010 Mar;65(3):271-6. doi: 10.1136/thx.2009.126771.
BACKGROUND
Clinical roles of QuantiFERON-TB Gold (QFT-G)/Gold in-Tube (QFT-G-IT) and T-SPOT.TB in tuberculosis require clarification.
METHODS
MEDLINE and EMBASE were searched for relevant English papers. Summary estimates of likelihood ratios (LR) of QFT-G/QFT-G-IT and T-SPOT.TB for latent tuberculosis infection (LTBI) and tuberculosis disease in adults were obtained by bivariate and univariate random effects meta-analyses after assessing heterogeneity. Probable ranges of prevalence for LTBI and tuberculosis disease were estimated. Critical values of positive LR (PLR) and negative LR (NLR) corresponding to a 90% certainty threshold were calculated over probable prevalence ranges. It was considered reliable to rule in when the best estimated PLR exceeds the corresponding critical value and to rule out when the best estimated NLR is less than the corresponding critical value.
RESULTS
35 studies involving predominantly immunocompetent adults were identified. Based on bivariate meta-analysis, PLR (95% CI) for LTBI were 7.9 (3.6 to 17.3) for T-SPOT.TB and 48.1 (19.7 to 117.6) and 10.8 (5.3 to 21.8) for QFT-G/QFT-G-IT based on Japanese and other studies, respectively. Corresponding NLR (95% CI) were 0.10 (0.06 to 0.18), 0.11 (0.07 to 0.18) and 0.23 (0.16 to 0.32). PLR (95% CI) for tuberculosis disease were 3.6 (2.3 to 5.6) for QFT-G, 2.1 (1.1 to 4.0) for QFT-G-IT and 4.7 (2.4 to 9.1) and 2.3 (1.3 to 4.0) for T-SPOT.TB based on studies with mean or median age >47. 1 years and < or = 47.1 years, respectively. Corresponding NLR (95% CI) were 0.18 (0.12 to 0.27), 0.38 (0.22 to 0.68), 0.11 (0.06 to 0.20) and 0.20 (0.10 to 0.40). Estimated prevalence ranges were 10-55% for LTBI and 40-60% for tuberculosis disease.
CONCLUSIONS
At a 90% certainty threshold, LTBI is best diagnosed by QFT-G/QFT-G-IT and excluded by T-SPOT.TB or QFT-G/QFT-G-IT; none can diagnose tuberculosis disease, whereas. T-SPOT.TB can exclude tuberculosis disease among middle-aged and older patients.
背景
需要明确 QuantiFERON-TB Gold（QFT-G）/Gold in-Tube（QFT-G-IT）和 T-SPOT.TB 在结核病中的临床作用。
方法
检索 MEDLINE 和 EMBASE 中的相关英文文献。通过双变量和单变量随机效应荟萃分析，评估异质性后，获得 QFT-G/QFT-G-IT 和 T-SPOT.TB 用于成人潜伏性结核感染（LTBI）和结核病的似然比（LR）的汇总估计值。估计 LTBI 和结核病的可能患病率范围。计算相应的 90%置信度阈值下阳性 LR（PLR）和阴性 LR（NLR）的临界值。当最佳估计的 PLR 超过相应的临界值时，认为可以可靠地排除，而当最佳估计的 NLR 小于相应的临界值时，则认为可以可靠地纳入。
结果
共确定了 35 项主要涉及免疫功能正常的成年人的研究。基于双变量荟萃分析，T-SPOT.TB 的 LTBI 的 PLR（95%CI）为 7.9（3.6 至 17.3），而 QFT-G/QFT-G-IT 的 PLR（95%CI）分别为基于日本和其他研究的 48.1（19.7 至 117.6）和 10.8（5.3 至 21.8）。相应的 NLR（95%CI）分别为 0.10（0.06 至 0.18）、0.11（0.07 至 0.18）和 0.23（0.16 至 0.32）。QFT-G 的结核病的 PLR（95%CI）为 3.6（2.3 至 5.6），QFT-G-IT 的 PLR（95%CI）为 2.1（1.1 至 4.0），T-SPOT.TB 的 PLR（95%CI）分别为 4.7（2.4 至 9.1）和 2.3（1.3 至 4.0）。研究的平均或中位年龄>47.1 岁和≤47.1 岁。相应的 NLR（95%CI）分别为 0.18（0.12 至 0.27）、0.38（0.22 至 0.68）、0.11（0.06 至 0.20）和 0.20（0.10 至 0.40）。估计的患病率范围为 LTBI 为 10-55%，结核病为 40-60%。
结论
在 90%置信度阈值下，QFT-G/QFT-G-IT 最适合诊断 LTBI，而 T-SPOT.TB 或 QFT-G/QFT-G-IT 最适合排除 LTBI；两者均不能诊断结核病，而 T-SPOT.TB 可用于排除中老年患者的结核病。
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