Tobaiqi Muhammad Abubaker, Alshamrani Musleh Naser, Sriram Shyamkumar, Mahmoud Ahmad Bakur, Fadlalmola Hammad Ali, Albadrani Muayad
Department of Family and Community Medicine and Medical Education, College of Medicine, Taibah University, Madinah 42353, Saudi Arabia.
Preventive Medicine Department, Prince Sultan Armed Forces Hospital in Madinah, Madinah 42375, Saudi Arabia.
Diagnostics (Basel). 2025 Sep 16;15(18):2343. doi: 10.3390/diagnostics15182343.
: The world health goal of eliminating tuberculosis (TB) is heavily hinged on timely and efficient diagnosis and treatment. The interferon-γ release assays (I.G.R.A.s) can diagnose infection and offer an alternative to the centuries-old tuberculin skin test (T.S.T.). Yet there is disagreement over replacing the T.S.T. with I.G.R.A.s as a standard tool. : We aim to assess the diagnostic ability of I.G.R.A.s compared with T.S.T. for detecting active TB cases. : A systematic review identified relevant studies from four databases. In the diagnostic meta-analysis conducted with OpenMeta Analyst software, we calculated the sensitivity (SN) and specificity (SP) for active TB detection via I.G.R.A. and T.S.T. methods compared to TB culture. Results included pooled estimates for SN and SP with 95% confidence intervals (CI), stratified by age, immunity, I.G.R.A. type, and T.S.T. cut-off. : Our meta-analysis revealed that TB diagnosis using T.S.T. showed an SN of 72.4% and SP of 79.3%, while I.G.R.A. demonstrated higher accuracy with an SN of 78.9% and SP of 85.7%. Subgroup analysis by age indicated that I.G.R.A. consistently outperformed T.S.T. in both adult and pediatric populations. Among immunocompromised individuals, T.S.T. had low SN (23%) but high SP (91.2%), whereas I.G.R.A. had higher SN (65.6%) but lower SP (81.9%). Immunocompetent subjects showed that T.S.T. had SN of 72% and SP of 87.3%, while I.G.R.A. had higher SN (82.9%) and SP (89.1%). Evaluation by I.G.R.A. type revealed that T-SPOT.GIT demonstrated a higher SN but lower SP compared to QFT-GIT. Assessing T.S.T. cut-offs, SP was highest (88.8%) at ≥15 mm, while SN peaked (71.6%) at ≥5 mm. : I.G.R.A. consistently showed higher diagnostic accuracy than T.S.T. across most studied subgroups, indicating its potential superiority in active TB diagnosis.
消除结核病（TB）的全球卫生目标严重依赖于及时有效的诊断和治疗。干扰素-γ释放检测（I.G.R.A.s）可诊断感染，并为已有数百年历史的结核菌素皮肤试验（T.S.T.）提供了一种替代方法。然而，对于用I.G.R.A.s取代T.S.T.作为标准工具存在分歧。
我们旨在评估I.G.R.A.s与T.S.T.相比检测活动性结核病病例的诊断能力。
一项系统评价从四个数据库中识别出相关研究。在用OpenMeta Analyst软件进行的诊断性荟萃分析中，我们计算了通过I.G.R.A.和T.S.T.方法与结核培养相比检测活动性结核病的敏感性（SN）和特异性（SP）。结果包括按年龄、免疫状态、I.G.R.A.类型和T.S.T.临界值分层的SN和SP的合并估计值及95%置信区间（CI）。
我们的荟萃分析显示，使用T.S.T.进行结核病诊断的SN为72.4%，SP为79.3%，而I.G.R.A.的准确性更高，SN为78.9%，SP为85.7%。按年龄进行的亚组分析表明，在成人和儿童人群中，I.G.R.A.始终优于T.S.T.。在免疫功能低下的个体中，T.S.T.的SN较低（23%）但SP较高（91.2%），而I.G.R.A.的SN较高（65.6%）但SP较低（81.9%）。免疫功能正常的受试者显示，T.S.T.的SN为72%，SP为87.3%，而I.G.R.A.的SN较高（82.9%），SP较高（89.1%）。按I.G.R.A.类型评估显示，与QFT-GIT相比，T-SPOT.GIT的SN较高但SP较低。评估T.S.T.临界值时，≥15 mm时SP最高（88.8%），≥5 mm时SN最高（71.6%）。
在大多数研究的亚组中，I.G.R.A.始终显示出比T.S.T.更高的诊断准确性，表明其在活动性结核病诊断中的潜在优势。
