γ干扰素释放试验诊断艾滋病患者潜伏结核感染的Meta分析

目的系统评价以皮肤菌素试验为参考标准,γ干扰素释放试验诊断艾滋病患者潜伏结核感染的临床价值。方法计算机检索EMBASE、PubMed、Cochrane图书馆、中国期刊全文数据库、中文科技期刊全文数据库、万方数字化期刊群,检索时间截止至2010年3月,并辅助其他检索,全面收集γ干扰素释放试验诊断艾滋病患者潜伏结核感染的研究。用Meta-Disc1.4软件对其敏感度、特异度、阳性似然比、阴性似然比等进行合并分析并绘制综合受试者工作特征曲线。结果最终纳入9个研究,Meta分析结果显示：QFT-G试验和T-SPOT.TB试验与结核菌素皮肤试验相比,敏感度、特异度、阳性似然比、阴性似然比、诊断比值比及综合受试者工作特征曲线下面积相应分别为44%、91%、4.83、0.59、10.85、0.8574和82%、75%、2.01、0.41、6.50、0.7739。结论γ干扰素释放试验适合用于进一步的鉴别诊断艾滋病患者是否处于潜伏结核,不适合结核感染的筛查。上述结果尚需更多设计严谨、科学的临床试验进一步证实。

The Diagnostic Value of IGRA for Latent Tuberculosis Infection in HIV Patients:A Meta-Analysis

Objective To assess the diagnostic value of IGRA for latent tuberculosis infection in HIV patients.Methods We searched PubMed,EMBASE,Cochrane Library,CNKI,CSJD,and WANFANG（2010.3）to find all diagnostic tests about IGRAs in latent tuberculosis infection in HIV patients.Meta-Disc software 1.4 was used to handle data from included studies.Results Nine studies met the eligibility criteria and were included.Compared with TST,the summary values of sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,OR,and SROC curve of QFT-G were 44%,91%,4.83,0.59,10.85,0.857 4 and T-SPOT.TB were 82%,75%,2.01,0.41,6.50,0.773 9 respectively.Conclusion IGRAs could be regarded as a differential diagnosis for latent tuberculosis infection in HIV groups,which need to be studied further in future because of the limitation of included studies in small sample and quality.