Warwick Evidence, Warwick Medical School, University of Warwick, Coventry.
Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry.
Int J Tuberc Lung Dis. 2019 Nov 1;23(11):1178-1190. doi: 10.5588/ijtld.18.0743.
The relative accuracy of interferon-gamma release assays (IGRAs) and the tuberculin skin test (TST) in identifying latent tuberculosis infection (LTBI) is uncertain. To perform a systematic review and meta-analysis to compare the sensitivity and specificity of IGRAs and TST for the prediction of progression to clinical tuberculosis (TB). We searched electronic databases (e.g., MEDLINE and EMBASE) from December 2009 to September 2018 for prospective studies that followed up individuals who had undergone testing with commercial IGRAs and/or TST but had not received treatment based on the test result. The sensitivity and specificity estimates were pooled using a Bayesian bivariate random-effects model. Twenty-five studies, mostly with moderate to high risk of bias and a mean follow-up time ranging from 1 to 5 years were included. TST (10-15 mm) tended to have lower sensitivity and higher specificity than QuantiFERON Gold In-Tube, T-SPOT. and TST (5 mm). The evidence did not indicate that any test outperformed the others due to wide and overlapping 95% credible intervals. The evidence following individuals who had undergone testing for LTBI and had progressed to clinical TB is sparse. We did not find that IGRAs were superior to TST or vice versa; however, as our findings are based on a small number of studies with methodological limitations and great uncertainty around the pooled estimates, the results should be interpreted with caution.
干扰素释放试验（IGRAs）和结核菌素皮肤试验（TST）在诊断潜伏性结核感染（LTBI）方面的相对准确性尚不确定。本研究旨在进行系统评价和荟萃分析，以比较 IGRAs 和 TST 预测进展为临床结核病（TB）的敏感性和特异性。我们从 2009 年 12 月至 2018 年 9 月，检索了电子数据库（如 MEDLINE 和 EMBASE），以查找前瞻性研究，这些研究随访了接受商业 IGRAs 和/或 TST 检测但未根据检测结果进行治疗的个体。使用贝叶斯二变量随机效应模型汇总敏感性和特异性估计值。纳入了 25 项研究，这些研究大多存在中度至高度偏倚风险，平均随访时间为 1 至 5 年。TST（10-15mm）的敏感性低于 QuantiFERON Gold In-Tube、T-SPOT.和 TST（5mm），特异性则高于后两者。由于可信区间较宽且相互重叠，证据并未表明任何一种检测方法优于其他方法。对于进行 LTBI 检测且进展为临床 TB 的个体，其随访证据较少。我们没有发现 IGRAs 优于 TST 或反之亦然；然而，由于我们的研究结果基于少数存在方法学局限性且汇总估计值存在较大不确定性的研究，因此应谨慎解释这些结果。
