T 细胞斑点试验和腺苷脱氨酶对胸腔积液结核性胸膜炎的诊断价值：系统评价和荟萃分析。
The diagnostic value of T cell spot test and adenosine deaminase in pleural effusion for tuberculous pleurisy: A systematic review and meta-analysis.
机构信息
Department of Clinical Laboratory, Shangrao People's Hospital, No. 86, Shuyuan Road, Xinzhou District, Shangrao City, Jiangxi Province, 334000, China.
Department of Respiratory and Critical Care Medicine, Shangrao People's Hospital, Shangrao, China.
出版信息
Tuberculosis (Edinb). 2022 Jul;135:102223. doi: 10.1016/j.tube.2022.102223. Epub 2022 Jun 22.
BACKGROUND
Tuberculous infection of T cell spot test (T-SPOT.TB) and adenosine deaminase (ADA) have a high diagnostic value in pleural effusion for tuberculous pleurisy. However, there were major differences in existing research in regard to the clinical application of the two trials. Therefore, we conducted a meta-analysis to systematically evaluate the diagnostic value of T-SPOT.TB and ADA.
METHODS
Pubmed, Web of Science and Embase databases were searched to compare diagnosis of tuberculous pleurisy by T-SPOT.TB and ADA. The search period was from inception to August 31, 2021. Statistical analyses were performed using Meta-disc 1.4, Revman 5.4 and Stata 16.0. Pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were determined. Summary receiver operating characteristic (SROC) curves and the area under the curve (AUC) were used to summarize overall diagnostic performance.
RESULTS
10 qualified original research studies were included, with a total of 2075 patients, of which were 1391 tuberculous pleurisy and 684 non-tuberculous pleurisy. The pooled estimates of diagnostic accuracy of T-SPOT.TB were as follows: sensitivity, 0.88 (95% CI: 0.86-0.90; I = 92.7%); specificity, 0.79 (95% CI: 0.76-0.82; I = 93.7%); PLR, 4.49 (95% CI: 2.29-8.80; I = 94.9%); NLR, 0.15 (95% CI: 0.08-0.30; I = 94.3%), DOR, 35.72 (95% CI: 11.15-114.47; I = 91.5%). The AUC for SROC was 0.9283 (95% CI: 0.8912-0.9654). The pooled estimates of diagnostic accuracy of ADA were as follows: sensitivity, 0.65 (95% CI: 0.62-0.67; I = 98.2%); specificity, 0.90 (95% CI: 0.88-0.92; I = 69.4%); PLR, 6.12 (95% CI: 4.71-7.96; I = 11.9%); NLR, 0.33 (95% CI: 0.12-0.89; I = 99.5%), DOR, 23.18 (95% CI: 12.75-42.14; I = 66.7%). The AUC for SROC was 0.9208 (95% CI: 0.9029-0.9387).
CONCLUSION
Both T-SPOT.TB and ADA had high value in the diagnosis of tuberculous pleurisy. The sensitivity of T-SPOT.TB was higher than ADA, but the specificity of ADA was higher than T-SPOT.TB. On the whole, T-SPOT. TB had similar diagnostic accuracy to ADA.
背景
结核感染 T 细胞斑点试验（T-SPOT.TB）和腺苷脱氨酶（ADA）在结核性胸膜炎的胸腔积液诊断中具有较高的诊断价值。然而，现有研究在这两项试验的临床应用方面存在较大差异。因此，我们进行了一项荟萃分析，以系统评估 T-SPOT.TB 和 ADA 的诊断价值。
方法
检索 Pubmed、Web of Science 和 Embase 数据库，比较 T-SPOT.TB 和 ADA 诊断结核性胸膜炎的效果。检索时间从创建到 2021 年 8 月 31 日。使用 Meta-disc 1.4、Revman 5.4 和 Stata 16.0 进行统计分析。汇总敏感性、特异性、阳性似然比（PLR）、阴性似然比（NLR）和诊断比值比（DOR）。采用综合受试者工作特征（SROC）曲线和曲线下面积（AUC）来总结整体诊断性能。
结果
共纳入 10 项合格的原始研究，共 2075 例患者，其中 1391 例为结核性胸膜炎，684 例为非结核性胸膜炎。T-SPOT.TB 诊断准确性的汇总估计值如下：敏感性为 0.88（95% CI：0.86-0.90；I²=92.7%）；特异性为 0.79（95% CI：0.76-0.82；I²=93.7%）；PLR 为 4.49（95% CI：2.29-8.80；I²=94.9%）；NLR 为 0.15（95% CI：0.08-0.30；I²=94.3%）；DOR 为 35.72（95% CI：11.15-114.47；I²=91.5%）。SROC 的 AUC 为 0.9283（95% CI：0.8912-0.9654）。ADA 诊断准确性的汇总估计值如下：敏感性为 0.65（95% CI：0.62-0.67；I²=98.2%）；特异性为 0.90（95% CI：0.88-0.92；I²=69.4%）；PLR 为 6.12（95% CI：4.71-7.96；I²=11.9%）；NLR 为 0.33（95% CI：0.12-0.89；I²=99.5%）；DOR 为 23.18（95% CI：12.75-42.14；I²=66.7%）。SROC 的 AUC 为 0.9208（95% CI：0.9029-0.9387）。
结论
T-SPOT.TB 和 ADA 对结核性胸膜炎的诊断均具有较高的价值。T-SPOT.TB 的敏感性高于 ADA，但 ADA 的特异性高于 T-SPOT.TB。总体而言，T-SPOT.TB 与 ADA 具有相似的诊断准确性。
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