Comparing interferon-gamma release assays with tuberculin skin test for identifying latent tuberculosis infection that progresses to active tuberculosis: systematic review and meta-analysis.
Comparing interferon-gamma release assays with tuberculin skin test for identifying latent tuberculosis infection that progresses to active tuberculosis: systematic review and meta-analysis.
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DOI：
10.1186/s12879-017-2301-4
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发表时间：
2017-03-09
影响因子：
3.7
通讯作者：
Clarke A
中科院分区：
文献类型：
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作者：
Auguste P;Tsertsvadze A;Pink J;Court R;McCarthy N;Sutcliffe P;Clarke A
及时、准确地识别结核潜伏感染者对控制结核分枝杆菌感染具有重要意义。LTBI的诊断尚无金标准。干扰素伽玛释放试验(IGRAs)和结核菌素皮肤试验(TST)等筛查试验提供了间接和不完善的信息。这项系统性综述比较了两种IGRAs Quantiferon®-TB Gold In-Tube test(QFT-GIT)和T-SPOT.TB与TST在通过预测三个亚组(儿童、免疫功能低下者和最近来自高结核病负担国家的人)的进展而被诊断为活动性结核病来识别LTBI方面的差异。队列研究符合纳入条件。我们检索了2009年12月至2015年6月的MEDLINE、EMBASE、Cochrane图书馆和其他数据库。一位评价者筛选研究，提取数据，并通过另一位评价者的交叉核对来评估偏见的风险。使用累积发病率(95%的CI)来总结检测结果与结核病发病率之间的关联强度。综合疗效指标：CIR(R-CIR)占95%顺位的比率。R-CIR采用随机效应模型进行合并。异质性用卡方和I2统计量进行评估。纳入了17项研究，主要是中度或高度偏见(5名儿童，10名免疫受损的人，2名新近到达的人)。在儿童中，虽然在两项研究中，QFT-GIT和TST(≥5 mm)(合并R-CIR = 1.11，95%CI：0.71，1.74)没有显著差异，但另外两项研究显示QFT-GIT在诊断下颅脑损伤方面优于TST(≥10 mm)。在免疫功能低下的人群中，IGRA(T-SPOT.TB)与TST(≥10 mm)在鉴别LTBI方面无显著差异(合并R-CIR = 1.01，95%CI：0.65，1.58)。在来自结核病高负担国家的新近抵达的人群中进行的两项研究的森林小区显示出不一致的结果(高度异质性；I2 = 为92%)。比较IGRA检测和TST检测从LTBI到TB进展的前瞻性研究很少，由于不确定性、偏见风险和无法解释的异质性，这些结果应该谨慎解释。为了充分比较IGRA和TST在结核病高危人群中的效果，需要进行具有足够样本量和后续行动的基于人群的研究。本文的在线版本(doi：10.1186/s12879-0172301-4)包含补充材料，授权用户可以使用。
Timely and accurate identification of people with latent tuberculosis infection (LTBI) is important for controlling Mycobacterium tuberculosis (TB). There is no gold standard for diagnosis of LTBI. Screening tests such as interferon gamma release assays (IGRAs) and tuberculin skin test (TST) provide indirect and imperfect information. This systematic review compared two types of IGRAs QuantiFERON®-TB Gold In-Tube test (QFT-GIT) and T-SPOT.TB with TST for identification of LTBI by predicting progression to a diagnosis of active TB in three subgroups: children, immunocompromised people, and those recently arrived from countries with high TB burden. Cohort studies were eligible for inclusion. We searched MEDLINE, EMBASE, the Cochrane Library and other databases from December 2009 to June 2015. One reviewer screened studies, extracted data, and assessed risk of bias with cross checking by a second reviewer. Strength of association between test results and incidence of TB was summarised using cumulative incidence ratios (CIRs with 95% CIs). Summary effect measures: the ratio of CIRs (R-CIR) with 95% CIs. R-CIRs, were pooled using a random-effects model. Heterogeneity was assessed using Chi-squared and I2 statistics. Seventeen studies, mostly of moderate or high risk of bias (five in children, 10 in immunocompromised people, and two in those recently arrived) were included. In children, while in two studies, there was no significant difference between QFT-GIT and TST (≥5 mm) (pooled R-CIR = 1.11, 95% CI: 0.71, 1.74), two other studies showed QFT-GIT to outperform TST (≥10 mm) in identifying LTBI. In immunocompromised people, IGRA (T-SPOT.TB) was not significant different from TST (≥10 mm) for identifying LTBI, (pooled R-CIR = 1.01, 95% CI: 0.65, 1.58). The forest plot of two studies in recently arrived people from countries with high TB burden demonstrated inconsistent findings (high heterogeneity; I2 = 92%). Prospective studies comparing IGRA testing against TST on the progression from LTBI to TB were sparse, and these results should be interpreted with caution due to uncertainty, risk of bias, and unexplained heterogeneity. Population-based studies with adequate sample size and follow-up are required to adequately compare the performance of IGRA with TST in people at high risk of TB. The online version of this article (doi:10.1186/s12879-017-2301-4) contains supplementary material, which is available to authorized users.