背景:在过敏性支气管肺曲霉病(ABPA)合并哮喘患者中,免疫测定法与免疫沉淀法检测烟曲霉特异性IgG的诊断准确性尚不清楚。
方法:我们进行了系统评价,以确定在同一ABPA受试者中描述两种方法的研究。我们使用QUADAS-2工具评估研究质量。我们使用HSROCmeta回归模型推导了相对灵敏度和特异性。我们使用免疫测定法计算了需要测试的数量,以检测ABPA中的另一项阳性测试。
结果:我们的搜索产生了20项研究(796例ABPA和929例对照)。这些研究有很高的偏倚风险。免疫沉淀方法的敏感性和特异性的汇总估计为68.6%(95%CI,48.4-83.5)和93.8%(95%CI,83.6-97.8),分别,而对于免疫测定,它们分别为85.2%(95%CI,73.3-92.3)和84.6%(95%CI,76.0-90.5),分别。与免疫沉淀测试相比,免疫测定的相对敏感性和特异性分别为1.29(95%CI,1.1-1.6)和0.91(95%CI,0.85-0.97),分别。与免疫沉淀相比,自动免疫测定(1.77;95%CI,1.1-2.8)比手动(1.1;95%CI,1.02-1.18)具有更好的相对灵敏度。手动免疫测定的相对特异性(0.95;95%CI,0.91-0.99)显着降低,而自动化(0.88;95%CI,0.77-1.0)的检测结果较低,但无统计学差异.对于用免疫测定(相对于免疫沉淀)进行的每六个(95%CI,5-7)测试,检测到一个额外的阳性结果。
结论:与免疫治疗方法相比,自动化免疫测定具有更高的灵敏度和相似的特异性,手工免疫测定具有较高的灵敏度和较低的特异性,而自动免疫测定对检测ABPA患者的烟曲霉IgG具有更高的灵敏度和相似的特异性。[www.crd.约克。AC.uk/prospro/display_record.php?RecordID=309864]。
BACKGROUND: The diagnostic accuracy of immunoassays versus
immunoprecipitation methods for detecting A.fumigatus-specific IgG in patients with allergic bronchopulmonary aspergillosis (ABPA) complicating asthma remains unclear.
METHODS: We performed a systematic
review to identify studies describing both the methods in the same ABPA subjects. We assessed study quality using the QUADAS-2 tool. We derived the relative sensitivity and specificity using the HSROC meta-regression model. We calculated the number-needed-to-test using an immunoassay to detect one additional positive test in ABPA.
RESULTS: Our search yielded 20 studies (796 ABPA and 929 controls). The studies had a high risk of bias. The summary estimates for sensitivity and specificity of
immunoprecipitation methods were 68.6% (95% CI, 48.4-83.5) and 93.8% (95% CI, 83.6-97.8), respectively, while for immunoassays they were 85.2% (95% CI, 73.3-92.3) and 84.6% (95% CI, 76.0-90.5), respectively. The relative sensitivity and specificity of immunoassays compared to
immunoprecipitation tests were 1.29 (95% CI, 1.1-1.6) and 0.91 (95% CI, 0.85-0.97), respectively. The automated immunoassays (1.77; 95% CI, 1.1-2.8) had better relative sensitivity than the manual (1.1; 95% CI, 1.02-1.18) assays compared to
immunoprecipitation. The relative specificity of manual immunoassays (0.95; 95% CI, 0.91-0.99) was significantly lower, while that of automated (0.88; 95% CI, 0.77-1.0) assays was lower but not statistically different. One additional positive result was detected for every six (95% CI, 5-7) tests performed with immunoassay (versus immunoprecipitation).
CONCLUSIONS: Compared to immunoprecipiation methods, automated immunoassays have higher sensitivity and similar specificity, manual immunoassays have higher sensitivity and lower specificity, while automated immunoassays have higher sensitivity and similar specificity for detecting A.fumigatus-IgG in patients with ABPA. [www.crd.york.ac.uk/prospero/display_record.php?RecordID=309864].