背景:涂片阴性肺结核(SNPTB)的诊断具有挑战性。干扰素γ释放测定(IGRAs)可能有助于这些患者的早期诊断,从而导致及时的治疗和良好的结果。
方法:我们从每个数据库开始到2021年4月5日进行了全面搜索。提供有关IGRAs的敏感性和特异性的足够数据的研究包括QuantiFERON-TB金管(QFT-GIT),T-SPOT。TB,包括用于诊断SNPTB的QuantiFERON-TBGoldPlus。
结果:在筛选的1,312项研究中,纳入16项研究;11项QFT-GIT,2T-SPOT。TB,和3QFT-GIT和T-SPOT。TB。对于SNPTB的诊断,QFT-GIT的灵敏度为0.77(95%CI0.71-0.82),特异性为0.70(95%CI0.58-0.80),诊断优势比(DOR)为8.03(95%CI4.51-14.31),正似然比(LR)为2.61(95%CI1.80-3.80),负LR为0.33(95%CI0.25-0.42),接收器工作特性下面积(AUROC)为0.81(95%CI0.77-0.84)。T-SPOT。结核病的敏感性为0.74(95%CI0.71-0.78),特异性为0.71(95%CI0.49-0.86),DOR为6.96(95%CI2.31-20.98),正LR为2.53(95%CI1.26-5.07),负LR为0.36(95%CI0.24-0.55),AUROC为0.77(95%CI0.73-0.80)。与来自低结核病负担的研究相比,来自高结核病负担县的研究的亚组分析中的特异性似乎较低。
结论:IGRA对SNPTB的诊断能力不足。然而,这些测试仍然有助于在低测试前概率的患者中排除结核病。登记处:PROSPERO:CRD42021274653。
BACKGROUND: The diagnosis of smear-negative pulmonary tuberculosis (SNPTB) is challenging. Interferon gamma-release assays (IGRAs) may be helpful in early diagnosis among these patients resulting in prompt treatment and favorable outcomes.
METHODS: We performed a comprehensive search from each databases\' inception to April 5, 2021. The studies that provided sufficient data regarding the sensitivity and specificity of IGRAs included QuantiFERON-TB Gold In-Tube (QFT-GIT), T-SPOT.TB, or QuantiFERON-TB Gold Plus for diagnosis of SNPTB were included.
RESULTS: Of 1,312 studies screened, 16 studies were included; 11 QFT-GIT, 2 T-SPOT.TB, and 3 QFT-GIT and T-SPOT.TB. For diagnosis of SNPTB, QFT-GIT had sensitivity of 0.77 (95% CI 0.71-0.82), specificity of 0.70 (95% CI 0.58-0.80), diagnostic odds ratio (DOR) of 8.03 (95% CI 4.51-14.31), positive likelihood ratio (LR) of 2.61 (95% CI 1.80-3.80), negative LR of 0.33 (95% CI 0.25-0.42), and area under receiver operating characteristic (AUROC) of 0.81 (95% CI 0.77-0.84). T-SPOT.TB had sensitivity of 0.74 (95% CI 0.71-0.78), specificity of 0.71 (95% CI 0.49-0.86), DOR of 6.96 (95% CI 2.31-20.98), positive LR of 2.53 (95% CI 1.26-5.07), negative LR of 0.36 (95% CI 0.24-0.55), and AUROC of 0.77 (95% CI 0.73-0.80). The specificity seemed lower in the subgroup analyses of studies from high tuberculosis burden counties compared to the studies from low tuberculosis burden.
CONCLUSIONS: IGRAs do have insufficient diagnostic performance for SNPTB. However, the tests are still helpful to exclude tuberculosis among patients with low pre-test probability. Registry: PROSPERO: CRD42021274653.