■我们旨在评估干扰素γ释放测定(IGRAs)在潜伏结核感染(LTBI)检测中的不确定速率。
■2022年11月15日,我们搜索了PubMed®(国家医学图书馆,贝塞斯达,MD,美国),Embase®(爱思唯尔,阿姆斯特丹,荷兰),和Cochrane图书馆数据库符合系统审查和荟萃分析(PRISMA)指南的首选报告项目。两名研究人员独立提取了研究数据,并使用改进的诊断准确性研究质量评估来评估其质量(即,QUADAS-2)工具。使用随机效应模型来计算合并结果。
■我们纳入了403项研究,涉及486,886名个体,发现合并不确定率为3.9%(95%CI3.5%-4.2%)。QuantiFERON®-TB(QFT)的合并不确定速率与T-SPOT®相似。TB(T-SPOT)[比值比(OR)=0.88,95%CI0.59-1.32];然而,新一代QFT(QFT+)的不确定率低于T-SPOT(OR=0.24,95%CI0.16-0.35)。免疫功能低下人群的不确定率明显高于健康对照组(OR=3.51,95%CI2.11-5.82)。并且随着HIV阳性患者CD4+细胞计数的减少而增加。儿童合并不确定率(OR=2.56,95%CI1.79-3.57)明显高于成人,随着儿童年龄的下降,发病率也随之上升。
■平均而言,26个测试中有1个在LTBI筛选中产生不确定的IGRA结果。使用QuantiFERON-TB测定(QFT-plus)的高级版本,可能会减少不确定结果的发生。我们的研究强调了与不确定的IGRA相关的免疫抑制和年轻的高风险,这在LTBI的管理中应该得到更多的关注。
■PROSPEROhttps://www.crd.约克。AC.uk/prospro/display_record.php?ID=CRD42020211363,CRD42020211363。
We aimed to evaluate the
indeterminate rate of interferon gamma release assays (IGRAs) in the detection of latent tuberculosis infection (LTBI).
On 15 November 2022, we searched the PubMed® (National Library of Medicine, Bethesda, MD, USA), Embase® (Elsevier, Amsterdam, the Netherlands), and Cochrane Library databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two investigators independently extracted the study data and assessed their quality using a modified quality assessment of diagnostic accuracy studies (i.e., QUADAS-2) tool. A random-effects model was used to calculate pooled results.
We included 403 studies involving 486,886 individuals and found that the pooled
indeterminate rate was 3.9% (95% CI 3.5%-4.2%). The pooled
indeterminate rate for QuantiFERON®-TB (QFT) was similar to that for T-SPOT®.TB (T-SPOT) [odds ratio (OR) = 0.88, 95% CI 0.59-1.32]; however, the
indeterminate rate for a new generation of QFT (QFT-plus) was lower than that of T-SPOT (OR = 0.24, 95% CI 0.16-0.35). The indeterminate rate in the immunocompromised population was significantly higher than that in healthy controls (OR = 3.51, 95% CI 2.11-5.82), and it increased with the reduction of CD4+ cell count in HIV-positive patients. Children\'s pooled indeterminate rates (OR = 2.56, 95% CI 1.79-3.57) were significantly higher than those of adults, and the rates increased as the children\'s age decreased.
On average, 1 in 26 tests yields
indeterminate IGRA results in LTBI screening. The use of advanced versions of the QuantiFERON-TB assay (QFT-plus), may potentially reduce the occurrence of an indeterminate result. Our study emphasizes the high risk of immunosuppression and young age in relation to indeterminate IGRA, which should receive more attention in the management of LTBI.
PROSPERO https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020211363, CRD42020211363.