Predictive Value of Interferon-γ Release Assays and Tuberculin Skin Testing for Progression From Latent TB Infection to Disease State A Meta-analysis
Predictive Value of Interferon-γ Release Assays and Tuberculin Skin Testing for Progression From Latent TB Infection to Disease State A Meta-analysis
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DOI：
10.1378/chest.11-3157
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发表时间：
2012-07-01
期刊：
影响因子：
9.6
通讯作者：
Nienhaus, Albert
中科院分区：
文献类型：
--
作者：
Diel, Roland;Loddenkemper, Robert;Nienhaus, Albert
背景：鉴于目前缺乏有效的结核病疫苗，确定或排除潜伏性结核感染（LTBI）的筛查试验的准确性对有效控制结核病至关重要。本荟萃分析批判性地评价了研究干扰素- γ释放试验（IGRAs）和结核菌素皮肤试验（TST）从测试确定的LTBI状态进展为活动性结核病的阳性和阴性预测值（分别为PPV和NPV）的研究。方法：检索MEDLINE、EMBASE和Cochrane的相关文献。在定性评估之后，使用固定和随机效应模型汇总了商业化和“内部”IGRA进展的PPV和NPV以及在各自IGRA研究背景下未接受预防性治疗的患者的TST。计算了所有研究人群和仅处于结核病发展高风险的人群的加权比率。结果：使用商业IGRAs的所有研究的进展PPV为2.7% (95% CI, 2.3%-3.2%)，而TST的合并PPV为1.5% (95% CI, 1.2%-1.7%) （P < 0.0001）。当仅考虑高危人群时，IGRAs和TST的PPV分别增加到6.8% （95% CI, 5.6%-8.3%）和2.4% (95% CI, 1.9%-2.9%) （P < 0.0001）。IGRAs和TST进展的NPV合并值都非常高，分别为99.7% （95% CI, 99.5%-99.8%）和99.4% (95% CI, 99.2%-99.5%)，尽管IGRAs的NPV合并值明显更高（P < 0.01）。结论：与TST相比，商业化IGRAs对进展为活动性结核病的PPV和NPV更高，特别是在高危人群中。胸部2012;142 (1): 63 - 75
Background: Given the current lack of effective vaccines against TB, the accuracy of screening tests for determining or excluding latent TB infection (LTBI) is decisive in effective TB control. This meta-analysis critically appraises studies investigating the positive and the negative predictive value (PPV and NPV, respectively) from a test-determined LTBI state for progression to active TB of interferon-gamma release assays (IGRAs) and the tuberculin skin test (TST).Methods: We searched MEDLINE, EMBASE, and Cochrane bibliographies for relevant articles. After qualitative evaluation, the PPV and NPV for progression of commercial and "in-house" IGRAs and the TST for persons not receiving preventive treatment in the context of the respective IGRA studies were pooled using both a fixed and a random-effect model. Weighted rates were calculated for all study populations and for groups solely at high risk of TB development.Results: The pooled PPV for progression for all studies using commercial IGRAs was 2.7% (95% CI, 2.3%-3.2%) compared with 1.5% (95% CI, 1.2%-1.7%) for the TST (P < .0001). PPV increased to 6.8% (95% CI, 5.6%-8.3%) and 2.4% (95% CI, 1.9%-2.9%) for the IGRAs and the TST, respectively, when only high-risk groups were considered (P < .0001). Pooled values of NPV for progression for both IGRAs and the TST were very high, at 99.7% (95% CI, 99.5%-99.8%) and 99.4% (95% CI, 99.2%-99.5%), respectively, although they were significantly higher for IGRAs (P < .01).Conclusions: Commercial IGRAs have a higher PPV and NPV for progression to active TB compared with those of the TST, especially when performed in high-risk persons. CHEST 2012; 142(1):63-75