γ-干扰素释放试验对结核性脑膜炎的诊断准确性：系统评价和荟萃分析。
Diagnostic Accuracy of Interferon-Gamma Release Assays for Tuberculous Meningitis: A Systematic Review and Meta-Analysis.
机构信息
Department of Neurology, Jiangxi Provincial People's Hospital (The First Affiliated Hospital of Nanchang Medical College), Nanchang, China.
Institution of Neurology, Jiangxi Provincial People's Hospital (The First Affiliated Hospital of Nanchang Medical College), Nanchang, China.
出版信息
Front Cell Infect Microbiol. 2022 Apr 22;12:788692. doi: 10.3389/fcimb.2022.788692. eCollection 2022.
BACKGROUND
In this study, we evaluated and compared the accuracy of blood and cerebrospinal fluid (CSF) interferon release tests [interferon-gamma release assays (IGRAs)] in the diagnosis of tuberculous meningitis (TBM) by a meta-analysis of the relevant literature.
METHODS
We searched for studies published before 2021 in Medline, Embase, the Cochrane database, and Chinese databases. All studies used the QuantiFERON-TB Gold In-Tube and/or T-SPOT.TB method. Blood and/or CSF tests that met the guidelines for the quality assessment of studies with diagnostic accuracy were included. We used the revised diagnostic accuracy study quality assessment to assess the quality of the included studies. Begg's funnel plots were used to assess publication bias in the meta-analysis of the diagnostic studies, and statistical analyses were performed by using Stata (Version 12) software.
RESULTS
A total of 12 blood and/or CSF IGRA studies were included in this meta-analysis, with 376 patients and 493 controls. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the summary receiver operating characteristic curve (SROC) of the blood IGRAs in the pooled data from 12 studies were 74% (95% CI: 0.65-0.82), 78% (95% CI: 0.68-0.86), 3.38 (95% CI 2.26-5.06), 0.33 (95% CI: 0.23-0.46), 10.25 (95% CI: 5.46-19.25), and 0.83 (95% CI: 0.79-0.86), respectively. For CSF IGRAs, these values for the pooled data from the 10 studies included were 79% (95% CI: 0.71-0.85), 95% (95% CI: 0.88-0.98), 16.30 (95% CI 6.5-40.83), 0.22 (95% CI: 0.16-0.31), 57.93 (95% CI: 22.56-148.78), and 0.91 (95% CI: 0.88-0.93), respectively.
CONCLUSION
CSF IGRAs exhibited a better diagnostic accuracy than blood IGRAs in diagnosing TBM.
背景
本研究通过对相关文献的荟萃分析，评估和比较了血液和脑脊液（CSF）干扰素释放试验（干扰素-γ释放测定法[IGRAs]）在结核性脑膜炎（TBM）诊断中的准确性。
方法
我们检索了 2021 年前在 Medline、Embase、Cochrane 数据库和中文数据库中发表的研究。所有研究均使用 QuantiFERON-TB Gold In-Tube 和/或 T-SPOT.TB 方法。纳入符合研究质量评估指南的血液和/或 CSF 检测。我们使用修订后的诊断准确性研究质量评估来评估纳入研究的质量。贝叶斯漏斗图用于评估荟萃分析中诊断研究的发表偏倚，并使用 Stata（版本 12）软件进行统计分析。
结果
本荟萃分析共纳入 12 项血液和/或 CSF IGRAs 研究，共纳入 376 例患者和 493 例对照。12 项研究汇总数据的血液 IGRAs 的灵敏度、特异度、阳性似然比、阴性似然比、诊断优势比和汇总受试者工作特征曲线下面积（SROC）分别为 74%（95%CI：0.65-0.82）、78%（95%CI：0.68-0.86）、3.38（95%CI 2.26-5.06）、0.33（95%CI：0.23-0.46）、10.25（95%CI：5.46-19.25）和 0.83（95%CI：0.79-0.86）。对于 CSF IGRAs，纳入的 10 项研究汇总数据的这些值分别为 79%（95%CI：0.71-0.85）、95%（95%CI：0.88-0.98）、16.30（95%CI 6.5-40.83）、0.22（95%CI：0.16-0.31）、57.93（95%CI：22.56-148.78）和 0.91（95%CI：0.88-0.93）。
结论
CSF IGRAs 在诊断 TBM 方面的诊断准确性优于血液 IGRAs。
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