Department of Pulmonary Medicine, Medical School Hannover (MHH), Hannover, Institute for Health Service Research in Dermatology and Nursing, Hamburg, Germany.
The German Central Committee Against Tuberculosis, Berlin, Institute for Health Service Research in Dermatology and Nursing, Hamburg, Germany.
Chest. 2012 Jul;142(1):63-75. doi: 10.1378/chest.11-3157.
Given the current lack of effective vaccines against TB, the accuracy of screening tests for determining or excluding latent TB infection (LTBI) is decisive in effective TB control. This meta-analysis critically appraises studies investigating the positive and the negative predictive value (PPV and NPV, respectively) from a test-determined LTBI state for progression to active TB of interferon-γ release assays (IGRAs) and the tuberculin skin test (TST).
We searched MEDLINE, EMBASE, and Cochrane bibliographies for relevant articles. After qualitative evaluation, the PPV and NPV for progression of commercial and “in-house” IGRAs and the TST for persons not receiving preventive treatment in the context of the respective IGRA studies were pooled using both a fixed and a random-effect model. Weighted rates were calculated for all study populations and for groups solely at high risk of TB development.
The pooled PPV for progression for all studies using commercial IGRAs was 2.7% (95% CI, 2.3%-3.2%) compared with 1.5% (95% CI, 1.2%-1.7%) for the TST (P < .0001). PPV increased to 6.8% (95% CI, 5.6%-8.3%) and 2.4% (95% CI, 1.9%-2.9%) for the IGRAs and the TST, respectively, when only high-risk groups were considered (P < .0001). Pooled values of NPV for progression for both IGRAs and the TST were very high, at 99.7% (95% CI, 99.5%-99.8%) and 99.4% (95% CI, 99.2%-99.5%), respectively, although they were significantly higher for IGRAs (P < .01).
Commercial IGRAs have a higher PPV and NPV for progression to active TB compared with those of the TST, especially when performed in high-risk persons.
鉴于目前缺乏有效的结核病疫苗，用于确定或排除潜伏性结核病感染（LTBI）的筛查试验的准确性对于结核病的有效控制至关重要。本荟萃分析批判性地评估了从试验确定的 LTBI 状态到干扰素-γ释放测定（IGRA）和结核菌素皮肤试验（TST）进展为活动性结核病的进展的阳性和阴性预测值（PPV 和 NPV）的研究。
我们在 MEDLINE、EMBASE 和 Cochrane 文献中搜索了相关文章。经过定性评估，使用固定效应模型和随机效应模型对未接受预防治疗的商业和“内部”IGRA 以及 TST 的所有研究人群和高结核病风险人群进行了荟萃分析。计算了所有研究人群和仅高结核病发展风险人群的加权率。
使用商业 IGRAs 的所有研究的汇总 PPV 为 2.7%（95%CI，2.3%-3.2%），而 TST 的汇总 PPV 为 1.5%（95%CI，1.2%-1.7%）（P<.0001）。当仅考虑高风险组时，IGRA 和 TST 的 PPV 分别增加至 6.8%（95%CI，5.6%-8.3%）和 2.4%（95%CI，1.9%-2.9%）（P<.0001）。两种 IGRAs 和 TST 的进展 NPV 汇总值均非常高，分别为 99.7%（95%CI，99.5%-99.8%）和 99.4%（95%CI，99.2%-99.5%），尽管 IGRAs 的 NPV 明显更高（P<.01）。
与 TST 相比，商业 IGRA 对活动性结核病进展的 PPV 和 NPV 更高，尤其是在高风险人群中进行时。
