Accuracy of the interferon-γ release assay for the diagnosis of active tuberculosis among HIV-seropositive individuals: a systematic review and meta-analysis.
Accuracy of the interferon-γ release assay for the diagnosis of active tuberculosis among HIV-seropositive individuals: a systematic review and meta-analysis.
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DOI：
10.1186/s12879-016-1687-8
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发表时间：
2016-07-22
影响因子：
3.7
通讯作者：
Peng L
中科院分区：
文献类型：
--
作者：
Huo ZY;Peng L
尽管γ-干扰素释放试验（IGRA）已成为诊断潜伏性结核感染（LTBI）的广泛接受的手段，但IGRA在诊断人类免疫缺陷病毒（HIV）血清阳性个体中的活动性结核（ATB）中的作用仍存在争议。以往的分析没有为筛选具有严格对照组的文章建立合理的纳入标准，也没有为ATB诊断建立金标准。因此，我们对最新证据进行了系统回顾，以评估IGRA对HIV血清阳性患者的准确性。最初，我们检索了EMBASE、科克伦和MEDLINE数据库，以查找2000年1月至2015年10月期间发表的使用QuantiFERON-TB Gold In-Tube检测试剂盒（QFT-IT）或T-SPOT.TB检测试剂盒（T-SPOT）在HIV血清阳性个体中诊断ATB的研究文章。我们分别计算了合并的灵敏度、特异性和不确定事件的比例，然后使用森林图总结结果，以估计QFT-IT和T-SPOT检测的准确度。检索后共发现1，743项研究; 11项研究符合我们的选择标准，并纳入荟萃分析。QFT-IT试验的合并灵敏度和特异性分别为69%（95%CI，50- 84%，I2 = 85.22%）和76%（95%CI，53- 90%，I2 = 98.16%），最佳曲线下面积（AUC）为0.78（95%CI，0.74-0.82）。T-SPOT试验的合并灵敏度和特异性分别为89%（95%CI，66- 97%，I2 = 94.48%）和87%（95%CI，38- 99%，I2 = 97.92%），AUC为0.93（95%CI，0.90-0.95）。QFT-IT和T-SPOT检测不确定结果的合并比值为0.07（95% CI，0.06-0.09，I2 = 74.8%）和0.19（95% CI，0.15-0.24，I2 = 88.3%），分别使用固定效应模型计算，和0.08（95% CI，0.06-0.12，I2 = 74.8%）和0.10（95% CI，0.03-0.25，I2 = 88.3%），使用随机效应模型计算。IGRA似乎不是HIV血清阳性患者ATB病例临床确认的最佳方法;然而，T-SPOT检测在区分HIV感染者中的ATB病例方面可能比QFT-IT检测具有更高的准确性，而QFT-IT检测似乎减少了不确定结果的发生。此外，需要修改和额外的试验设计，以提高诊断有效性。
Although the interferon-γ release assay (IGRA) has become a widely accepted means for the diagnosis of latent tuberculosis infection (LTBI), the role of the IGRA in diagnosing active tuberculosis (ATB) among human immunodeficiency virus (HIV)-seropositive individuals remains controversial. Previous analyses did not set up rational inclusive criteria for screening articles with strict control groups and a gold standard for ATB diagnosis. Therefore, we conducted a systematic review of the latest evidence to evaluate the accuracy of IGRA for HIV-seropositive patients. Initially, we searched the EMBASE, Cochrane and MEDLINE databases to find research articles published from January 2000 to October 2015 that used the QuantiFERON-TB Gold In-Tube assay (QFT-IT) or the T-SPOT.TB assay (T-SPOT) to diagnose ATB among HIV-seropositive individuals. We separately calculated the pooled sensitivity, specificity, and proportion of indeterminate events and then summarized the results using forest plots to estimate the accuracy of the QFT-IT and T-SPOT assays. A total of 1,743 studies were discovered after searching; 11 studies met our selection standards and were included for meta-analysis. The pooled sensitivity and specificity of the QFT-IT assay were 69 % (95 % CI, 50–84 %, I2 = 85.22 %) and 76 % (95 % CI, 53–90 %, I2 = 98.16 %), respectively, and the optimum area under the curve (AUC) was 0.78 (95 % CI, 0.74–0.82). The pooled sensitivity and specificity of the T-SPOT assay were 89 % (95 % CI, 66–97 %, I2 = 94.48 %) and 87 % (95 % CI, 38–99 %, I2 = 97.92 %), respectively, and the AUC was 0.93 (95 % CI, 0.90–0.95). The pooled ratios of the indeterminate results of the QFT-IT and T-SPOT assays were 0.07 (95 % CI, 0.06–0.09, I2 = 74.8 %) and 0.19 (95 % CI, 0.15–0.24, I2 = 88.3 %), respectively, calculated using the fixed effect model, and 0.08 (95 % CI, 0.06–0.12, I2 = 74.8 %) and 0.10 (95 % CI, 0.03–0.25, I2 = 88.3 %), respectively, calculated using the random effects model. The IGRA does not appear to be optimal for the clinical confirmation of ATB cases in HIV-seropositive patients; however, the T-SPOT assay may have greater accuracy in distinguishing ATB cases among HIV-infected individuals than the QFT-IT assay, while the QFT-IT assay appears to reduce the occurrence of indeterminate results. Furthermore, modification and additional trial designs are required to improve diagnostic effectiveness.