Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Infection. 2019 Jun;47(3):353-361. doi: 10.1007/s15010-019-01285-7. Epub 2019 Feb 25.
The diagnostic accuracy of interferon-gamma release assays (IGRAs) and the tuberculin skin test (TST) for latent tuberculosis infection (LTBI) in transplant candidates is uncertain.
Pubmed, Embase and Cochrane library were searched to identify relevant studies. Quality of included studies was assessed with RevMan5 software (via GUADAS2 checklist). Accuracy measures of IGRAs and TST assays (sensitivity, specificity and others) were pooled with random effects model. Data were analyzed by STATA and Meta-DiSc.
Twenty-eight studies were selected for full review, and 16 were included in the final analysis. The pooled sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR) for TST were 46% [95% confidence interval (CI) 38-54%], 86% (95% CI 75-93%), 46.3% (95% CI 40-52), 88.7% (95% CI 87-89), 3.3 (95% CI 1.6-6.4), 0.63 (95% CI 0.52-0.77) and 5 (95% CI 2-12), respectively. For QFT-G, the pooled sensitivity, specificity, PPV, NPV, PLR, NLR, and DOR were 58% (95% CI 41-73%), 89% (95% CI 77-95%), 72.7% (95% CI 68-76), 80.6% (95% CI 78-82), 5.3 (95% CI 2.0-14.0), 0.47 (95% CI 0.30-0.75) and 11 (95% CI 3-46), respectively. Likewise, for T-SPOT.TB, the pooled sensitivity, specificity, PPV, NPV, PLR, NLR, and DOR were 55% (95% CI 40-70%), 92% (95% CI 87-95%), 60.4% (95% CI 47-72), 90.2% (95% CI 86-92), 6.7 (95% CI 4.0-11.1), 0.52 (95% CI 0.31-0.85) and 16 (95% CI 7-37), respectively.
IGRAs were more sensitive and specific than the TST with regard to the diagnosis of LTBI in the transplant candidates. They have added value and can be complementary to TST.
干扰素 - 伽马释放试验（IGRAs）和结核菌素皮肤试验（TST）在移植候选者中用于潜伏性结核感染（LTBI）的诊断准确性尚不确定。
通过 Pubmed、Embase 和 Cochrane 图书馆检索相关研究。使用 RevMan5 软件（通过 GUADAS2 清单）评估纳入研究的质量。使用随机效应模型汇总了 IGRAs 和 TST 检测的准确性测量值（敏感性、特异性和其他）。使用 STATA 和 Meta-DiSc 进行数据分析。
选择了 28 项研究进行全面审查，其中 16 项研究纳入最终分析。TST 的汇总敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、阳性似然比（PLR）、阴性似然比（NLR）和诊断比值比（DOR）分别为 46%（95%CI 38-54%）、86%（95%CI 75-93%）、46.3%（95%CI 40-52%）、88.7%（95%CI 87-89%）、3.3（95%CI 1.6-6.4）、0.63（95%CI 0.52-0.77）和 5（95%CI 2-12）。对于 QFT-G，汇总敏感性、特异性、PPV、NPV、PLR、NLR 和 DOR 分别为 58%（95%CI 41-73%）、89%（95%CI 77-95%）、72.7%（95%CI 68-76%）、80.6%（95%CI 78-82%）、5.3（95%CI 2.0-14.0）、0.47（95%CI 0.30-0.75）和 11（95%CI 3-46）。同样，对于 T-SPOT.TB，汇总敏感性、特异性、PPV、NPV、PLR、NLR 和 DOR 分别为 55%（95%CI 40-70%）、92%（95%CI 87-95%）、60.4%（95%CI 47-72%）、90.2%（95%CI 86-92%）、6.7（95%CI 4.0-11.1）、0.52（95%CI 0.31-0.85）和 16（95%CI 7-37）。
与 TST 相比，IGRAs 在移植候选者中诊断 LTBI 时更敏感和特异。它们具有附加值，可以与 TST 互补。
