γ 干扰素释放试验诊断实体器官移植术前患者潜伏结核感染的Meta分析

    Diagnostic Value of IGRA for Latent Tuberculosis Infection in Solid Organ Transplant Recipients before Transplantation: A Meta-Analysis

    • 摘要: 目的 以结核菌素试验为参考标准,系统评价γ干扰素释放试验在诊断实体器官移植术前患者潜伏结核感染的临床价值。 方法 计算机检索PubMed、EMBASE、Cochrane 图书馆,检索时间为建库至2012年8月,全面收集γ干扰素释放试验诊断实体器官移植术前患者潜伏结核感染的研究。用Meta Disc 1.4软件对其合并的特异度、敏感度、阴性似然比、阳性似然比等进行分析,绘制综合受试者工作特征曲线。 结果 最终纳入6个包括QFT-IT试验和T-SPOT试验的γ干扰素释放试验的研究。QFT-IT试验和T-SPOT试验对实体器官移植术前患者潜伏结核感染的诊断价值的合并特异度、合并敏感度、合并阳性似然比、合并阴性似然比、合并诊断比值比及综合受试者工作特征曲线下面积分别为81%、74%、3.94、0.33、12.44、0.847 8 和78%、75%、3.61、0.32、12.07、0.845 0。 结论 经综合受试者工作特征曲线证实,γ干扰素释放试验在实体器官移植术前患者潜伏结核感染诊断中,不适用于结核感染的筛查,也不适合进一步鉴别诊断移植术前患者是否处于潜伏结核,上述结果尚需更多科学的、设计严谨的临床试验进一步证实。

       

      Abstract: Objective To assess the diagnostic value of IGRA for latent tuberculosis infection in solid organ transplant recipients. Methods We searched PubMed,EMBASE and Cochrane library to evaluate the evidence of using QuantiFERON-TB Gold in-tube (QFT-IT) and T-SPOT on blood for the diagnosis of latent tuberculosis infection in solid organ transplant recipients. Meta Disc 1.4 was used to handle data from included studies. Results The search identified 6 eligible studies that included 751 transplant recipients before transplantation. Compared with TST, the summary values of specificity,sensitivity, positive likelihood ratio, negative likelihood ratio,OR,and SROC curve of QFT-IT and T-SPOT were 81%,74%,3.94,0.33,12.44,0.847 8 and 78%,75%,3.61,0.32,12.07,0.845 0, respectively. Conclusion IGRA in their current formulations has limited accuracy in diagnosing latent tuberculosis infection in transplant recipients, and should not be used alone to rule out or rule in latent tuberculosis infection in transplant recipients. Further modification is needed to improve their accuracy.

       

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