结核分枝杆菌感染的干扰素γ释放试验的转换或逆转：一项系统评价和荟萃分析

Conversion or Reversion of Interferon γ Release Assays for Mycobacterium tuberculosis Infection: A Systematic Review and Meta-analysis.

作者信息

Wang Mao-Shui, Li-Hunnam Jarrod, Chen Ya-Li, Gilmour Beth, Alene Kefyalew Addis, Zhang Yan-An, Nicol Mark P

机构信息

Department of Lab Medicine, Shandong Public Health Clinical Center, Shandong University, Jinan, China.

Shandong Key Laboratory of Infectious Respiratory Disease, Jinan, China.

出版信息

Clin Infect Dis. 2025 Feb 5;80(1):168-179. doi: 10.1093/cid/ciae357.

DOI:10.1093/cid/ciae357

PMID:38954503

Abstract

BACKGROUND

Interferon γ release assays (IGRAs) are widely used for diagnosis of latent tuberculosis infection. However, with repeated testing, IGRA transformation (conversion or reversion) may be detected and is challenging to interpret. We reviewed the frequency of and risk factors for IGRA transformation.

METHODS

We screened public databases for studies of human participants that reported the frequency of IGRA transformation. We extracted study and participant characteristics, details of IGRA testing and results. We calculated the pooled frequency of IGRA transformation (and transient transformation) and examined associated risk factors.

RESULTS

The pooled frequency of IGRA conversion or reversion from 244 studies was estimated at 7.3% (95% confidence interval [CI], 6.1%-8.5%) or 22.8% (20.1%-25.7%), respectively. Transient conversion or reversion were estimated at 46.0% (95% CI, 35.7%-56.4%) or 19.6% (9.2%-31.7%) of conversion or reversion events respectively. Indeterminate results seldom reverted to positive (1.2% [95% CI, .1%-3.5%]). IGRA results in the borderline-positive or borderline-negative range were associated with increased risk of conversion or reversion (pooled odds ratio [OR] for conversion, 4.15 [95% CI, 3.00-5.30]; pooled OR for reversion, 4.06 [3.07-5.06]). BCG vaccination was associated with decreased risk of conversion (OR, 0.70 [95% CI, .56-.84]), cigarette smoking with decreased risk of reversion (0.44 [.06-.82]), and female sex with decreased risk of either conversion or reversion (OR for conversion, 0.66 [.58-.75]; OR for reversion, 0.46 [.31-.61]).

CONCLUSIONS

IGRA conversion is less common than reversion, and frequently transient. Research is needed to determine whether individuals with reversion would benefit from tuberculosis-preventive treatment. Retesting of people with indeterminate results is probably not indicated, because indeterminate results seldom revert to positive.

摘要

背景

干扰素γ释放试验（IGRAs）广泛用于潜伏性结核感染的诊断。然而，重复检测时，可能会检测到IGRA转变（转换或逆转），且难以解释。我们回顾了IGRA转变的频率及危险因素。

方法

我们在公共数据库中筛选报告了IGRA转变频率的人体研究。我们提取了研究和参与者特征、IGRA检测细节及结果。我们计算了IGRA转变（及短暂转变）的合并频率，并检查相关危险因素。

结果

244项研究中IGRA转换或逆转的合并频率估计分别为7.3%（95%置信区间[CI]，6.1%-8.5%）或22.8%（20.1%-25.7%）。短暂转换或逆转分别估计占转换或逆转事件的46.0%（95%CI，35.7%-56.4%）或19.6%（9.2%-31.7%）。不确定结果很少逆转至阳性（1.2%[95%CI，0.1%-3.5%]）。IGRA结果处于临界阳性或临界阴性范围与转换或逆转风险增加相关（转换的合并比值比[OR]，4.15[95%CI，3.00-5.30]；逆转的合并OR，4.06[3.07-5.06]）。卡介苗接种与转换风险降低相关（OR，0.70[95%CI，0.56-0.84]），吸烟与逆转风险降低相关（0.44[0.06-0.82]），女性与转换或逆转风险降低相关（转换的OR，0.66[0.58-0.75]；逆转的OR，0.46[0.31-0.61]）。