干扰素-γ释放试验在儿童结核分枝杆菌感染诊断中应用的系统评价和荟萃分析：2013年更新
Systematic review and meta-analysis on the utility of Interferon-gamma release assays for the diagnosis of Mycobacterium tuberculosis infection in children: a 2013 update.
作者信息
Sollai S, Galli L, de Martino M, Chiappini E
出版信息
BMC Infect Dis. 2014;14 Suppl 1(Suppl 1):S6. doi: 10.1186/1471-2334-14-S1-S6. Epub 2014 Jan 8.
BACKGROUND
Previous meta-analyses regarding the performance of interferon-gamma release assays (IGRAs) for tuberculosis diagnosis in children yielded contrasting results, probably due to different inclusion/exclusion criteria.
METHODS
We systematically searched PubMed, EMBASE and Cochrane databases and calculated pooled estimates of sensitivities and specificities of QuantiFERON-TB Gold In Tube (QFT-G-IT), T-SPOT.TB, and tuberculin skin test (TST). Several sub-analysis were performed: stratification by background (low income vs. high income countries); including only microbiological confirmed TB cases; including only studies performing a simultaneous three-way comparison of the three tests, and including immunocompromised children.
RESULTS
Overall, 31 studies (6183 children) for QFT-G-IT, 14 studies (2518 children) for T-SPOT.TB and 34 studies (6439 children) for TST were included in the analyses. In high income countries QFT-G-IT sensitivity was 0.79 (95%IC: 0.75-0.82) considering all the studies, 0.78 (95%CI:0.70-0.84) including only studies performing a simultaneous three-way comparison and 0.86 (95%IC 0.81-0.90) considering only microbiologically confirmed studies. In the same analyses T-SPOT.TB sensitivity was 0.67 (95%IC 0.62-0.73); 0.76 (95%CI: 0.68 to 0.83); and 0.79 (95%IC 0.69-0.87), respectively. In low income countries QFT-G-IT pooled sensitivity was significantly lower: 0.57 (95%IC:0.52-0.61), considering all the studies, and 0.66 (95%IC 0.55-0.76) considering only microbiologically confirmed cases; while T-SPOT.TB sensitivity was 0.61 (95%IC 0.57-0.65) overall, but reached 0.80 (95%IC 0.73-0.86) in microbiologically confirmed cases. In microbiologically confirmed cases TST sensitivity was similar: 0.86 (95%IC 0.79-0.91) in high income countries, and 0.74 (95%IC 0.68-0.80) in low income countries. Higher IGRAs specificity with respect to TST was observed in high income countries (97-98% vs. 92%) but not in low income countries (85-93% vs. 90%).
CONCLUSIONS
Both IGRAs showed no better performance than TST in low income countries.
背景
先前关于干扰素-γ释放试验（IGRAs）用于儿童结核病诊断性能的荟萃分析得出了相互矛盾的结果，这可能是由于不同的纳入/排除标准所致。
方法
我们系统检索了PubMed、EMBASE和Cochrane数据库，并计算了全血γ-干扰素释放试验（QFT-G-IT）、结核感染T细胞检测（T-SPOT.TB）和结核菌素皮肤试验（TST）的敏感性和特异性的合并估计值。进行了多项亚分析：按背景分层（低收入国家与高收入国家）；仅纳入微生物学确诊的结核病病例；仅纳入对这三种检测进行同步三方比较的研究，以及纳入免疫功能低下的儿童。
结果
分析共纳入了31项关于QFT-G-IT的研究（6183名儿童）、14项关于T-SPOT.TB的研究（2518名儿童）和34项关于TST的研究（6439名儿童）。在高收入国家，考虑所有研究时，QFT-G-IT的敏感性为0.79（95%可信区间：0.75-0.82）；仅纳入进行同步三方比较的研究时为0.78（95%可信区间：0.70-0.84）；仅考虑微生物学确诊的研究时为0.86（95%可信区间0.81-0.90）。在相同分析中，T-SPOT.TB的敏感性分别为0.67（95%可信区间0.62-0.73）；0.76（95%可信区间：0.68至0.83）；以及0.79（95%可信区间0.69-0.87）。在低收入国家，QFT-G-IT的合并敏感性显著较低：考虑所有研究时为0.57（95%可信区间：0.52-0.61），仅考虑微生物学确诊病例时为0.66（95%可信区间0.55-0.76）；而T-SPOT.TB的总体敏感性为0.61（95%可信区间0.57-0.65），但在微生物学确诊病例中达到0.80（95%可信区间0.73-0.86）。在微生物学确诊病例中，TST的敏感性相似：在高收入国家为0.86（95%可信区间0.79-0.91），在低收入国家为0.74（95%可信区间0.68-0.80）。在高收入国家观察到IGRAs相对于TST具有更高的特异性（97-98%对92%），但在低收入国家并非如此（85-93%对90%）。
结论
在低收入国家，两种IGRAs的表现均不比TST更好。
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