γ-干扰素释放试验在 HIV 感染者潜伏结核感染诊断中的应用：系统评价和荟萃分析。
Interferon-gamma release assays for the diagnosis of latent tuberculosis infection in HIV-infected individuals: a systematic review and meta-analysis.
机构信息
Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA.
出版信息
J Acquir Immune Defic Syndr. 2011 Mar 1;56(3):230-8. doi: 10.1097/QAI.0b013e31820b07ab.
OBJECTIVE
To determine whether interferon-gamma release assays (IGRAs) improve the identification of HIV-infected individuals who could benefit from latent tuberculosis infection therapy.
DESIGN
Systematic review and meta-analysis.
METHODS
We searched multiple databases through May 2010 for studies evaluating the performance of the newest commercial IGRAs (QuantiFERON-TB Gold In-Tube [QFT-GIT] and T-SPOT.TB [TSPOT]) in HIV-infected individuals. We assessed the quality of all studies included in the review, summarized results in prespecified subgroups using forest plots, and where appropriate, calculated pooled estimates using random effects models.
RESULTS
The search identified 37 studies that included 5736 HIV-infected individuals. In three longitudinal studies, the risk of active tuberculosis was higher in HIV-infected individuals with positive versus negative IGRA results. However, the risk difference was not statistically significant in the two studies that reported IGRA results according to manufacturer-recommended criteria. In persons with active tuberculosis (a surrogate reference standard for latent tuberculosis infection), pooled sensitivity estimates were heterogeneous but higher for TSPOT (72%; 95% confidence interval [CI], 62-81%) than for QFT-GIT (61%; 95% CI, 47-75%) in low-/middle-income countries. However, neither IGRA was consistently more sensitive than the tuberculin skin test in head-to-head comparisons. Although TSPOT appeared to be less affected by immunosuppression than QFT-GIT and the tuberculin skin test, overall, differences among the three tests were small or inconclusive.
CONCLUSIONS
Current evidence suggests that IGRAs perform similarly to the tuberculin skin test at identifying HIV-infected individuals with latent tuberculosis infection. Given that both tests have modest predictive value and suboptimal sensitivity, the decision to use either test should be based on country guidelines and resource and logistic considerations.
目的
确定干扰素 -γ 释放试验（IGRAs）是否能提高对可能受益于潜伏性结核感染治疗的 HIV 感染者的识别能力。
设计
系统评价和荟萃分析。
方法
我们通过 2010 年 5 月在多个数据库中搜索了评估最新商业 IGRAs（QuantiFERON-TB Gold In-Tube [QFT-GIT] 和 T-SPOT.TB [TSPOT]）在 HIV 感染者中的表现的研究。我们评估了所有纳入研究的质量，使用森林图在预设亚组中总结结果，并在适当情况下使用随机效应模型计算汇总估计值。
结果
搜索结果确定了 37 项研究，共纳入了 5736 名 HIV 感染者。在三项纵向研究中，IGRA 阳性与阴性的 HIV 感染者中，活动性结核病的风险更高。然而，在按照制造商推荐标准报告 IGRA 结果的两项研究中，风险差异无统计学意义。在活动性结核病患者（潜伏性结核感染的替代参考标准）中，汇总敏感性估计值存在异质性，但 TSPOT 的敏感性更高（72%；95%置信区间[CI]，62-81%），而 QFT-GIT 的敏感性较低（61%；95% CI，47-75%），在中低收入国家中。然而，在头对头比较中，IGRA 均未始终比结核菌素皮肤试验更敏感。尽管 TSPOT 似乎比 QFT-GIT 和结核菌素皮肤试验受免疫抑制的影响更小，但总体而言，三种试验之间的差异较小或不确定。
结论
目前的证据表明，IGRAs 在识别潜伏性结核感染的 HIV 感染者方面与结核菌素皮肤试验表现相似。鉴于两种检测方法的预测值均适中且敏感性欠佳，因此选择使用哪种检测方法应基于国家指南以及资源和物流方面的考虑。
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