Int J Immunopathol Pharmacol. 2012 Apr-Jun;25(2):335-43. doi: 10.1177/039463201202500203.
The role of interferon-gamma release assays (IGRAs) for immunologic diagnosis of tuberculosis in children is under debate. We carried out a narrative review on the studies on IGRAs in paediatric populations. A literature search was conducted using multiple keywords and standardized terminology in Medline, EMBASE and Cochrane databases, up to January 27th, 2011. Study quality was assessed using the MOOSE checklist and results of relevant studies were summarized. Sixty-seven paediatric studies (study population ranging from 14 to 5,244 children) were identified. Non-commercial ELISPOT assay (by means of ESAT-6 and CFP-10 antigens) had been carried out in 11 studies. QuantiFERON-TB Gold (QFT-G), QuantiFERON-TB Gold In-tube (QFT-G-IT), and T-SPOT.TB assays had been performed in 10, 44 and 18 studies, respectively. Most studies reported higher specificity of IGRA than tuberculin skin test (TST), but interpretation of the results is complicated by the fact that a gold standard for the diagnosis of latent TB is lacking. The reported sensitivity for active TB ranged from 51-93 percent for QFT-G/QFT-G-IT and 40-100 percent for ELISPOT assays, suggesting that a negative IGRA result may not exclude tuberculosis. Combining TST and IGRA results increased the diagnostic sensitivity. Rates of indeterminate results largely varied (0 to 35 percent). Most of the studies on young (less than 5 years) or immune-compromised children reported a proportion of indeterminate results exceeding 4 percent. Agreement among TST and IGRA, assessed by the k statistics, ranged from -0.03 to 0.87. Higher rates of discordance were reported in BCG-vaccinated than in non-BCG-vaccinated children. Studies on children less than 5 years and immunocompromised children reported conflicting results, as did studies on serial IGRA determinations. Despite the large amount of literature data, the role of IGRA in the pediatric population is still unclear, especially in young children. Combined use of TST/IGRA may increase diagnostic sensitivity but interpretation of discordant results remains a challenging issue.
干扰素 -γ 释放试验（IGRAs）在儿童结核病免疫诊断中的作用仍存在争议。我们对儿童人群中 IGRAs 的研究进行了叙述性综述。使用 Medline、EMBASE 和 Cochrane 数据库中的多个关键词和标准化术语进行了文献检索，检索时间截至 2011 年 1 月 27 日。使用 MOOSE 清单评估研究质量，并总结相关研究的结果。确定了 67 项儿科研究（研究人群范围为 14 至 5244 名儿童）。11 项研究中进行了非商业性酶联免疫斑点试验（使用 ESAT-6 和 CFP-10 抗原）。10 项、44 项和 18 项研究分别进行了 QuantiFERON-TB Gold（QFT-G）、QuantiFERON-TB Gold In-tube（QFT-G-IT）和 T-SPOT.TB 检测。大多数研究报告了 IGRAs 比结核菌素皮肤试验（TST）具有更高的特异性，但由于缺乏潜伏性结核的金标准，解释结果变得复杂。报告的活动性结核病的敏感性为 QFT-G/QFT-G-IT 为 51-93％，ELISPOT 检测为 40-100％，提示阴性 IGRAs 结果不能排除结核病。TST 和 IGRAs 结果的联合可提高诊断敏感性。不确定结果的比例差异很大（0 至 35％）。大多数关于年幼（<5 岁）或免疫功能低下儿童的研究报告的不确定结果比例超过 4％。TST 和 IGRAs 之间的一致性，通过 k 统计评估，范围从-0.03 到 0.87。BCG 疫苗接种儿童比非 BCG 疫苗接种儿童报告的不一致率更高。关于<5 岁儿童和免疫功能低下儿童的研究报告了相互矛盾的结果，关于连续 IGRAs 测定的研究也是如此。尽管有大量的文献数据，但 IGRAs 在儿科人群中的作用仍不清楚，尤其是在年幼的儿童中。TST/IGRA 的联合使用可能会提高诊断敏感性，但对不一致结果的解释仍然是一个具有挑战性的问题。
