Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA.
Int J Tuberc Lung Dis. 2011 Aug;15(8):1018-32. doi: 10.5588/ijtld.10.0631.
Children infected with Mycobacterium tuberculosis have significant risk of developing tuberculosis(TB) and can therefore benefit from preventive therapy.
To assess the value of interferon-gamma release assays (IGRAs) and the tuberculin skin test (TST)in the diagnosis of TB infection and disease in children.
Thirty-three studies were included, assessing commercial IGRAs (QuantiFERON®-TB [QFT] andT-SPOT.®TB) and TST. Reference standards for infection were incident TB or TB exposure. Test performance for disease diagnosis was evaluated in studies assessing children with confirmed and/or clinically diagnosed TB,compared to children where TB was excluded.
Two small studies measured incident TB in children tested with QFT and found weak positive predictive value. Association of test response with exposure-categorized dichotomously or as a gradient-was similar for all tests. The sensitivity and specificity of all tests were similar in diagnosing the disease. Stratified analysis suggested lower sensitivity for all tests in young or human immuno deficiency virus infected children.
Available data suggest that TST and IGRAs have similar accuracy for the detection of TB infection or the diagnosis of disease in children. Heterogeneous methodology limited the comparability of studies and the interpretation of results. A rigorous, standardized approach to evaluate TB diagnostic tests in children is needed.
感染结核分枝杆菌的儿童有发生结核病（TB）的重大风险，因此可以受益于预防性治疗。
评估干扰素 - γ释放试验（IGRAs）和结核菌素皮肤试验（TST）在儿童结核感染和疾病诊断中的价值。
共纳入 33 项研究，评估了商业 IGRAs（QuantiFERON®-TB [QFT] 和 T-SPOT.®TB）和 TST。感染的参考标准是新发 TB 或 TB 暴露。在评估确诊和/或临床诊断为 TB 的儿童与排除 TB 的儿童的疾病诊断时，评估了检测对疾病诊断的性能。
两项小型研究测量了 QFT 检测的儿童中新发 TB 的情况，发现阳性预测值较弱。所有试验的检测反应与暴露的分类（二分类或梯度）之间的关联相似。所有试验在诊断疾病时的敏感性和特异性相似。分层分析表明，在年轻或人类免疫缺陷病毒感染的儿童中，所有检测的敏感性均较低。
现有数据表明，TST 和 IGRAs 对检测儿童 TB 感染或诊断疾病的准确性相似。研究方法的异质性限制了研究的可比性和结果的解释。需要采用严格、标准化的方法来评估儿童的 TB 诊断检测。
