Predictive value of interferon-γ release assays for incident active tuberculosis: a systematic review and meta-analysis.
Predictive value of interferon-γ release assays for incident active tuberculosis: a systematic review and meta-analysis.
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DOI：
10.1016/s1473-3099(11)70210-9
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发表时间：
2012-01
影响因子：
56.3
通讯作者：
Pai, Madhukar
中科院分区：
文献类型：
--
作者：
Rangaka, Molebogeng X.;Wilkinson, Katalin A.;Glynn, Judith R.;Ling, Daphne;Menzies, Dick;Mwansa-Kambafwile, Judith;Fielding, Katherine;Wilkinson, Robert J.;Pai, Madhukar
我们的目的是评估干扰素-γ释放试验（IGRAs）是否可以预测活动性结核病的发展，以及这些试验的预测能力是否优于结核菌素皮肤试验（TST）。通过检索PubMed、Embase、Biosis和Web of Science以及补充手动检索，确定了内部或商业IGRA对活动性结核病预测价值的纵向研究，检索截止日期为2011年6月30日。合格的研究包括成人或儿童，有或没有艾滋病毒，谁是免费的活动性结核病在研究基线。我们在森林图中总结了发病率，并在适当时使用随机效应模型汇总了数据。我们计算了IGRA阳性与IGRA阴性个体疾病进展率的发病率比（IRR）。15项研究的总样本量为26680名受试者。在中位随访4年（IQR 2-6）期间，即使在IGRA阳性个体中，结核病的发病率也为4-48例/1000人-年。7项不可能存在纳入偏倚并基于IGRA结果报告基线分层的研究显示，阳性结果与随后的结核病之间存在中度相关性（汇总未校正IRR 2·10，95% CI 1·42-3·08）。与检测阴性结果相比，IGRA阳性和TST阳性结果在结核病风险方面几乎相同（在10 mm临界值时，IGRA和TST的合并IRR分别为2.11 [95% CI 1.29 - 3.46]和1.60 [0.94 - 2.72]）。然而，在评估IGRA和TST的11项研究中，有7项IGRA阳性个体的比例普遍低于TST阳性个体。IGRAs和TST对活动性结核病的预测都没有很高的准确性，尽管在某些人群中使用IGRAs可能会减少考虑进行预防性治疗的人数。在确定更多的预测性生物标志物之前，应根据不同人群的相对特异性、后勤、成本和患者的偏好来选择现有的潜伏性结核感染检测方法，而不仅仅是预测能力。热带疾病研究和培训特别方案（世卫组织）、惠康信托基金会、加拿大卫生研究所、英国医学研究理事会以及欧洲和发展中国家临床试验伙伴关系。
We aimed to assess whether interferon-γ release assays (IGRAs) can predict the development of active tuberculosis and whether the predictive ability of these tests is better than that of the tuberculin skin test (TST). Longitudinal studies of the predictive value for active tuberculosis of in-house or commercial IGRAs were identified through searches of PubMed, Embase, Biosis, and Web of Science and complementary manual searches up to June 30, 2011. Eligible studies included adults or children, with or without HIV, who were free of active tuberculosis at study baseline. We summarised incidence rates in forest plots and pooled data with random-effects models when appropriate. We calculated incidence rate ratios (IRR) for rates of disease progression in IGRA-positive versus IGRA-negative individuals. 15 studies had a combined sample size of 26 680 participants. Incidence of tuberculosis during a median follow-up of 4 years (IQR 2–6), even in IGRA-positive individuals, was 4–48 cases per 1000 person-years. Seven studies with no possibility of incorporation bias and reporting baseline stratification on the basis of IGRA results showed a moderate association between positive results and subsequent tuberculosis (pooled unadjusted IRR 2·10, 95% CI 1·42–3·08). Compared with test-negative results, IGRA-positive and TST-positive results were much the same with regard to the risk of tuberculosis (pooled IRR in the five studies that used both was 2·11 [95% CI 1·29–3·46] for IGRA vs 1·60 [0·94–2·72] for TST at the 10 mm cutoff). However, the proportion of IGRA-positive individuals in seven of 11 studies that assessed both IGRAs and TST was generally lower than TST-positive individuals. Neither IGRAs nor the TST have high accuracy for the prediction of active tuberculosis, although use of IGRAs in some populations might reduce the number of people considered for preventive treatment. Until more predictive biomarkers are identified, existing tests for latent tuberculosis infection should be chosen on the basis of relative specificity in different populations, logistics, cost, and patients’ preferences rather than on predictive ability alone. Special Programme for Research and Training in Tropical Diseases (WHO), Wellcome Trust, Canadian Institutes of Health Research, UK Medical Research Council, and the European and Developing Countries Clinical Trials Partnership.