Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic, Medicine, Second University of Naples, Naples, Italy.
Center of Excellence for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Service Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Occup Med Toxicol. 2015 Jan 27;10:2. doi: 10.1186/s12995-015-0044-y. eCollection 2015.
A systematic review and meta-analysis was conducted to evaluate the agreement between Tuberculin Skin Test (TST) and Quantiferon (QFT) in screening for tuberculosis (TB) infection among healthcare workers (HCWs) and to estimate associations between TST and QFT agreement and variables of interest, such as Bacillus Calmette-Guérin (BCG) vaccination and incidence of TB.
Cross-sectional and longitudinal studies on HCWs, published in English until October 2013, comparing TST and QFT results, were selected. For each study Cohen's κ value and a 95% confidence interval were calculated. Summary measures and indexes of heterogeneity between studies were calculated.
29 studies were selected comprising a total of 11,434 HCWs. Cohen's κ for agreement between TST and QFT for 24 of them was 0.28 (95% CI 0.22 to 0.35), with the best value in high TB incidence countries and the lowest rate of BCG vaccination.
Currently, there is no gold standard for TB screening and the most-used diagnostic tools show low agreement. For evidence-based health surveillance in HCWs, occupational physicians need to consider a number of factors influencing screening results, such as TB incidence, vaccination status, age and working seniority.
系统评价和荟萃分析评估了结核菌素皮肤试验（TST）和结核菌素干扰素释放试验（QFT）在筛查医护人员（HCW）结核病（TB）感染中的一致性，并估计 TST 和 QFT 一致性与感兴趣变量（如卡介苗（BCG）接种和 TB 发病率）之间的关联。
选择了截至 2013 年 10 月发表的比较 TST 和 QFT 结果的 HCW 的横断面和纵向研究。为每项研究计算了 Cohen's κ 值和 95%置信区间。计算了研究之间汇总指标和异质性指标。
选择了 29 项研究，共纳入 11434 名 HCW。其中 24 项研究 TST 和 QFT 之间的 Cohen's κ 为 0.28（95%CI 0.22 至 0.35），在 TB 发病率高的国家和 BCG 接种率最低的国家最佳。
目前，TB 筛查尚无金标准，最常用的诊断工具一致性较低。对于 HCW 的基于证据的健康监测，职业医生需要考虑影响筛查结果的许多因素，如 TB 发病率、疫苗接种状态、年龄和工作年限。
