Ma Yiyun, Xu Yuni, Cao Xiaoqiang, Chen Xiaojuan, Zhong Yeteng
Department of Laboratory Medicine, Hainan General Hospital, Haikou, Hainan, China.
Department of Laboratory Medicine, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China.
Epidemiol Infect. 2021 Aug 23;149:e204. doi: 10.1017/S0950268821001953.
Although the interferon-γ release assay (IGRA) has become a common diagnostic method for tuberculosis, its value in the diagnosis of tuberculosis in human immunodeficiency virus (HIV) seropositive patients remains controversial. Therefore, this systematically reviews the data for exploring the diagnostic value of IGRA in HIV-infected individuals complicated with active tuberculosis, aiming to provide a clinical basis for future clinical diagnosis of the disease.
Relevant studies on IGRA for diagnosing tuberculosis in HIV-infected patients were comprehensively collected from Excerpta Medica Database (EMBASE), Medline, Cochrane Library, Chinese Sci-tech Periodical Full-text Database, Chinese Periodical Full-text Database, China National Knowledge Infrastructure (CNKI) and China Wanfang Data up to July 2020. Subsequently, Stata 15.0, an integrated statistical software, was used to analyse the sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (PLR) and negative likelihood ratio (NLR) to create receiver operator characteristic (ROC) curves.
A total of 18 high-quality articles were selected, including 20 studies, 11 of which were related to QuantiFERON-TB Gold In-Tube (QFT-GIT) and nine to T-SPOT.TB. The meta-analysis indicated that the pooled sensitivity = 0.75 (95% CI 0.63-0.85), the pooled specificity = 0.82 (95% CI 0.66-0.92), PLR = 4.25 (95% CI 1.97-9.18), NLR = 0.30 (95% CI 0.18-0.50), DOR = 14.21 (95% CI 4.38-46.09) and the area under summary ROC curve was 0.85 (95% CI 0.81-0.88).
IGRA has a good diagnostic value and therefore can aid in the preliminary screening of active tuberculosis in HIV-infected individuals. Its diagnostic effectiveness can be improved by modifying and optimizing the assay design.
尽管干扰素-γ释放试验（IGRA）已成为结核病的常用诊断方法，但其在人类免疫缺陷病毒（HIV）血清学阳性患者结核病诊断中的价值仍存在争议。因此，本研究系统回顾相关数据，以探讨IGRA在合并活动性结核病的HIV感染者中的诊断价值，旨在为该疾病的未来临床诊断提供临床依据。
截至2020年7月，从荷兰医学文摘数据库（EMBASE）、医学文献数据库（Medline）、考克兰图书馆、中国科技期刊全文数据库、中国期刊全文数据库、中国知网（CNKI）和中国万方数据中全面收集关于IGRA诊断HIV感染患者结核病的相关研究。随后，使用综合统计软件Stata 15.0分析敏感性、特异性、诊断比值比（DOR）、阳性似然比（PLR）和阴性似然比（NLR），以绘制受试者工作特征（ROC）曲线。
共纳入18篇高质量文章，包括20项研究，其中11项与全血γ干扰素释放试验（QFT-GIT）相关，9项与结核感染T细胞检测（T-SPOT.TB）相关。荟萃分析表明，合并敏感性=0.75（95%可信区间0.63-0.85），合并特异性=0.82（95%可信区间0.66-0.92），PLR=4.25（95%可信区间1.97-9.18），NLR=0.30（95%可信区间0.18-0.50），DOR=14.21（95%可信区间4.38-46.09），汇总ROC曲线下面积为0.85（95%可信区间0.81-0.88）。
IGRA具有良好的诊断价值，因此有助于对HIV感染者的活动性结核病进行初步筛查。通过改进和优化检测设计可提高其诊断效能。
