干扰素释放试验在潜伏性结核感染筛查中的不确定结果：系统评价和荟萃分析。
Indeterminate results of interferon gamma release assays in the screening of latent tuberculosis infection: a systematic review and meta-analysis.
机构信息
Department of Science and Research, Anning First People's Hospital Affiliated to Kunming University of Science and Technology, Kunming, Yunnan, China.
Department of Medical Imaging, Yanan Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, China.
出版信息
Front Immunol. 2023 May 15;14:1170579. doi: 10.3389/fimmu.2023.1170579. eCollection 2023.
OBJECTIVES
We aimed to evaluate the indeterminate rate of interferon gamma release assays (IGRAs) in the detection of latent tuberculosis infection (LTBI).
METHODS
On 15 November 2022, we searched the PubMed® (National Library of Medicine, Bethesda, MD, USA), Embase® (Elsevier, Amsterdam, the Netherlands), and Cochrane Library databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two investigators independently extracted the study data and assessed their quality using a modified quality assessment of diagnostic accuracy studies (i.e., QUADAS-2) tool. A random-effects model was used to calculate pooled results.
RESULTS
We included 403 studies involving 486,886 individuals and found that the pooled indeterminate rate was 3.9% (95% CI 3.5%-4.2%). The pooled indeterminate rate for QuantiFERON®-TB (QFT) was similar to that for T-SPOT®.TB (T-SPOT) [odds ratio (OR) = 0.88, 95% CI 0.59-1.32]; however, the indeterminate rate for a new generation of QFT (QFT-plus) was lower than that of T-SPOT (OR = 0.24, 95% CI 0.16-0.35). The indeterminate rate in the immunocompromised population was significantly higher than that in healthy controls (OR = 3.51, 95% CI 2.11-5.82), and it increased with the reduction of CD4+ cell count in HIV-positive patients. Children's pooled indeterminate rates (OR = 2.56, 95% CI 1.79-3.57) were significantly higher than those of adults, and the rates increased as the children's age decreased.
CONCLUSION
On average, 1 in 26 tests yields indeterminate IGRA results in LTBI screening. The use of advanced versions of the QuantiFERON-TB assay (QFT-plus), may potentially reduce the occurrence of an indeterminate result. Our study emphasizes the high risk of immunosuppression and young age in relation to indeterminate IGRA, which should receive more attention in the management of LTBI.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020211363, CRD42020211363.
目的
评估干扰素释放试验（IGRAs）在检测潜伏性结核感染（LTBI）中的不确定率。
方法
2022 年 11 月 15 日，我们按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，检索了 PubMed®（美国国立医学图书馆，贝塞斯达）、Embase®（爱思唯尔，阿姆斯特丹）和 Cochrane 图书馆数据库。两位研究者独立提取研究数据，并使用改良的诊断准确性研究质量评估工具（即 QUADAS-2）评估其质量。使用随机效应模型计算汇总结果。
结果
我们纳入了 403 项研究，涉及 486886 人，发现汇总的不确定率为 3.9%（95%CI 3.5%-4.2%）。QuantiFERON®-TB（QFT）的不确定率与 T-SPOT®.TB（T-SPOT）相似[比值比（OR）=0.88，95%CI 0.59-1.32]；然而，新一代 QFT（QFT-plus）的不确定率低于 T-SPOT（OR=0.24，95%CI 0.16-0.35）。免疫功能低下人群的不确定率明显高于健康对照组（OR=3.51，95%CI 2.11-5.82），且随着 HIV 阳性患者 CD4+细胞计数的降低而升高。儿童的汇总不确定率（OR=2.56，95%CI 1.79-3.57）明显高于成人，且随着年龄的降低而升高。
结论
平均每 26 次 LTBI 筛查中就有 1 次产生不确定的 IGRA 结果。使用更先进的 QuantiFERON-TB 检测版本（QFT-plus）可能会降低不确定结果的发生。我们的研究强调了免疫抑制和年龄较小与不确定的 IGRA 相关的高风险，在 LTBI 的管理中应更加关注这一点。
系统评价注册
PROSPERO https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020211363，CRD42020211363。
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