用于诊断5岁以下儿童潜伏性结核分枝杆菌感染的γ干扰素释放试验：一项荟萃分析

Interferon-γ release assay for the diagnosis of latent Mycobacterium tuberculosis infection in children younger than 5 years: a meta-analysis.

作者信息

Ge Long, Ma Ji-Chun, Han Min, Li Jin-Long, Tian Jin-Hui

机构信息

The First Clinical Medicine College of Lanzhou University, Lanzhou, China Evidence-Based Medicine Center of Lanzhou University, Lanzhou, China.

Evidence-Based Medicine Center of Lanzhou University, Lanzhou, China

出版信息

Clin Pediatr (Phila). 2014 Nov;53(13):1255-63. doi: 10.1177/0009922814540040. Epub 2014 Jun 26.

DOI:10.1177/0009922814540040

PMID:24970465

Abstract

BACKGROUND

Interferon-γ release assays (IGRAs) have been widely used for the diagnosis of latent and active tuberculosis in adults, but their role in diagnosing latent tuberculosis infection (LTBI) in children younger than 5 years remains unclear.

OBJECTIVE

To evaluate the diagnostic performance of IGRAs for LTBI in children younger than 5 years.

METHODS

We searched the PubMed, EMBASE, Cochrane Library, and Web of Knowledge databases. According to inclusion criteria, the diagnostic studies of IGRAs for LTBI in children younger than 5 years were included. The study quality was assessed using the 14-item Quality Assessment of Diagnostic Accuracy Studies instrument. The Meta-Analyst software was used to analyze the data.

RESULTS

Seven studies (627 patients) were included. Meta-analysis showed that compared with tuberculin skin test (TST), the pooled sensitivity (Sen), specificity (Spe), positive likelihood ratio (PLR), negative likelihood ratio (NLR), positive predictive value (PPV), negative predictive value (NPV), accuracy and diagnosis odds ratio (DOR), and summary receiver operating characteristic (SROC) curve of QuantiFERON-TB (values in parentheses are 95% confidence intervals) were 0.841 (0.733-0.911), 0.895 (0.861-0.922), 8.046 (5.953-10.876), 0.192 (0.113-0.326), 0.622 (0.527-0.709), 0.970 (0.946-0.983), 0.891 (0.861-0.916), 50.718 (24.201-106.287), and 0.809 respectively. The pooled Sen, Spe, PLR, NLR, PPV, NPV, accuracy, DOR, and SROC curve of T-SPOT.TB test were 0.931 (0.760-0.983), 0.767 (0.684-0.833), 3.947 (2.854-5.459), 0.095 (0.026-0.354), 0.523 (0.398-0.645), 0.977 (0.914-0.994), 0.806 (0.737-0.860), 65.270 (13.463-316.434), and 0.855, respectively.

CONCLUSION

This meta-analysis showed that the sensitivity and specificity of IGRAs were slightly higher than TST and can be used as supporting tools to detect LTBI in children younger than 5 years. The methodological quality of diagnostic test needs to be improved.

摘要

背景

γ-干扰素释放试验（IGRAs）已广泛用于成人潜伏性和活动性结核病的诊断，但其在5岁以下儿童潜伏性结核感染（LTBI）诊断中的作用仍不明确。

目的

评估IGRAs对5岁以下儿童LTBI的诊断性能。

方法

检索PubMed、EMBASE、Cochrane图书馆和Web of Knowledge数据库。根据纳入标准，纳入5岁以下儿童LTBI的IGRAs诊断研究。使用诊断准确性研究质量评估的14项工具评估研究质量。使用Meta-Analyst软件分析数据。

结果

纳入7项研究（627例患者）。Meta分析显示，与结核菌素皮肤试验（TST）相比，QuantiFERON-TB的合并敏感度（Sen）、特异度（Spe）、阳性似然比（PLR）、阴性似然比（NLR）、阳性预测值（PPV）、阴性预测值（NPV）、准确度和诊断比值比（DOR）以及汇总受试者工作特征（SROC）曲线（括号内值为95%置信区间）分别为0.841（0.733 - 0.911）、0.895（0.861 - 0.922）、8.046（5.953 - 10.876）、0.192（0.113 - 0.326）、0.622（0.527 - 0.709）、0.970（0.946 - 0.983）、0.891（0.861 - 0.916）、50.718（24.201 - 106.287）和0.809。T-SPOT.TB试验的合并Sen、Spe、PLR、NLR、PPV、NPV、准确度、DOR和SROC曲线分别为0.931（0.760 - 0.983）、0.767（0.684 - 0.833）、3.947（2.854 - 5.459）、0.095（0.026 - 0.354）、0.523（0.398 - 0.645）、0.977（0.914 - 0.994）、0.806（0.737 - 0.860）、65.270（13.463 - 316.434）和0.855。