Pediatric Infectious Disease Research Center, Children's Medical Center Hospital, Tehran University of Medical Sciences, Dr. Gharib Street, Keshavarz Boulevard, Tehran, Iran.
Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Arch Immunol Ther Exp (Warsz). 2020 Feb 3;68(1):4. doi: 10.1007/s00005-020-00568-4.
The number of studies which evaluated interferon-gamma release assays (IGRAs) results after anti-tuberculosis (TB) treatment has been rapidly increasing. The aim of this study was to investigate the potential use of IGRAs (QFT-GIT, T-SPOT.TB, QFT-Plus) in assessing the response to anti-TB treatment. We searched all studies in English language published from 1 October 2011 to 18 November 2018 in PubMed, Web of Science, and Scopus. Our search included the term "tuberculosis treatment AND interferon-γ release assay". We included studies evaluating the performance of commercial IGRAs (including QFT-GIT, T-SPOT.TB and QFT-Plus) before and after the anti-TB treatment. We performed subgroup analysis based on the age (children, adults), type of TB (active, latent, active and latent, and contacts exposed to MDR defined as MDR LTBI), type of IGRAs (QFT-GIT and T-SPOT.TB), and follow-up interval (2, 3, 4, 6, 9 months). Of the 18 included studies, 12 used QFT-GIT for assessment of IGRA performance after therapy, 1 used T-SPOT.TB, and 3 used both QFT-GIT and T-SPOT.TB. Since then, only two studies have assessed the QFT-Plus performance during therapy. According to the results of the meta-analysis, the pooled rate of positive IGRAs (QFT-GIT and T-SPOT.TB) following anti-TB therapy was estimated at 76% [95% CI 70-81%] and no difference was found compared to the pooled positive rate of IGRAs before initiation of therapy which was 76% [95% CI 60-89%]. The subgroup analysis showed that the pooled rate of positive IGRAs (QFT-GIT and T-SPOT.TB) after anti-TB therapy was significantly higher in monitoring active TB subjects [80% (95% CI 74-88%)] than LTBI [71% (95% CI 70-81%)]. Available data are now sufficient to suggest that monitoring changes in the IGRAs (QFT-GIT and T-SPOT.TB) response during anti-TB treatment may have limited use in evaluating the effectiveness of treatment, while the monitoring changes in QFT-Plus during anti-tubercular treatment are recommended to determine treatment efficacy or for treatment monitoring. Further research is needed to establish the efficacy of this new assay as marker on a larger scale for treatment monitoring.
评估抗结核（TB）治疗后干扰素-γ释放试验（IGRAs）结果的研究数量迅速增加。本研究旨在探讨 IGRA（QFT-GIT、T-SPOT.TB、QFT-Plus）在评估抗 TB 治疗反应中的潜在用途。我们在 PubMed、Web of Science 和 Scopus 中搜索了 2011 年 10 月 1 日至 2018 年 11 月 18 日发表的所有英文研究。我们的搜索包括“结核治疗和干扰素-γ释放试验”一词。我们纳入了评估商业 IGRA（包括 QFT-GIT、T-SPOT.TB 和 QFT-Plus）在抗 TB 治疗前后性能的研究。我们根据年龄（儿童、成人）、TB 类型（活动、潜伏、活动和潜伏、以及接触 MDR 定义为 MDR LTBI）、IGRA 类型（QFT-GIT 和 T-SPOT.TB）和随访间隔（2、3、4、6、9 个月）进行亚组分析。在纳入的 18 项研究中，有 12 项使用 QFT-GIT 评估治疗后 IGRA 性能，1 项使用 T-SPOT.TB，3 项同时使用 QFT-GIT 和 T-SPOT.TB。此后，只有两项研究评估了 QFT-Plus 在治疗期间的性能。根据荟萃分析的结果，抗 TB 治疗后 QFT-GIT 和 T-SPOT.TB 的阳性 IGRA 总发生率估计为 76%[95%CI70-81%]，与治疗开始前 IGRA 的阳性总发生率 76%[95%CI60-89%]相比，差异无统计学意义。亚组分析显示，在监测活动性 TB 患者时，抗 TB 治疗后 QFT-GIT 和 T-SPOT.TB 的阳性 IGRA 总发生率明显更高[80%（95%CI74-88%）]，而非 LTBI[71%（95%CI70-81%）]。目前已有足够的数据表明，监测抗 TB 治疗期间 IGRA（QFT-GIT 和 T-SPOT.TB）反应的变化可能对评估治疗效果的作用有限，而在抗结核治疗期间监测 QFT-Plus 的变化被推荐用于确定治疗效果或治疗监测。需要进一步的研究来确定这种新检测方法作为更大规模治疗监测标志物的疗效。
