Department of Respiratory Diseases, Union Hospital, Key Lab of Pulmonary Diseases of Health Ministry, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Respirology. 2011 Apr;16(3):473-80. doi: 10.1111/j.1440-1843.2011.01941.x.
The diagnosis of tuberculous pleurisy by analysis of pleural fluid using standard diagnostic tools is difficult. Recently, T-cell interferon-γ release assays (IGRA) have been introduced for the diagnosis of tuberculous pleurisy. The aim of the present meta-analysis was to establish the overall diagnostic accuracy of IGRA on both pleural fluid and peripheral blood, for diagnosing tuberculous pleurisy.
A systematic review was performed of English language publications. Sensitivity, specificity and other measures of the accuracy of IGRA for the diagnosis tuberculous pleurisy using both pleural fluid and blood were pooled using a random-effects model or a fixed-effects model. Receiver operating characteristic curves were used to summarize overall test performance.
Seven out of eight studies met the inclusion criteria. The summary estimates of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value and diagnostic odds ratio were, for pleural fluid: 0.75, 0.82, 3.49, 0.24, 0.85, 0.70 and 19.04, respectively; and for blood: 0.80, 0.72, 2.86, 0.28, 0.78, 0.74 and 11.06, respectively.
As almost 20% of non-tuberculosis patients would be erroneously treated for tuberculosis and 25% of patients with tuberculous pleurisy would be missed, pleural fluid IGRA are not useful for the clinical diagnosis of tuberculous pleurisy.
使用标准诊断工具分析胸腔积液来诊断结核性胸膜炎较为困难。近来，γ-干扰素释放试验（IGRA）已被用于结核性胸膜炎的诊断。本荟萃分析的目的是评估胸腔积液和外周血中 IGRA 对结核性胸膜炎的总体诊断准确性。
对英文文献进行系统综述。使用随机效应模型或固定效应模型汇总了胸腔积液和血液中使用 IGRA 诊断结核性胸膜炎的敏感性、特异性和其他准确性测量值。受试者工作特征曲线用于总结总体检测性能。
八项研究中有七项符合纳入标准。胸腔积液的汇总估计敏感性、特异性、阳性似然比、阴性似然比、阳性预测值、阴性预测值和诊断比值比分别为 0.75、0.82、3.49、0.24、0.85、0.70 和 19.04；血液的分别为 0.80、0.72、2.86、0.28、0.78、0.74 和 11.06。
由于近 20%的非结核患者会被错误地进行结核病治疗，25%的结核性胸膜炎患者会被漏诊，因此胸腔积液 IGRA 对结核性胸膜炎的临床诊断没有帮助。
