干扰素γ释放试验和结核菌素皮肤试验诊断筛查儿童结核病和潜伏结核感染研究Meta分析

摘要

目的 探讨干扰素γ释放试验和结核菌素皮肤试验(PPD)在儿童结核病和潜伏结核感染诊断中的价值.方法 检索1990年1月至2011年2月在PUBMED、MEDLINE、OVID、CNKI等数据库发表的有关文献,并追查相关文献的参考文献,对文献按照诊断试验的纳入标准进行筛选.采用敏感度和特异度作为诊断价值的评价指标.采用Meta-Disc 1.4软件进行Meta分析.结果 QuantiFERON-TB Gold In-Tube在确诊结核病和(或)临床诊断结核病患儿中的汇总敏感度为67％,在对照儿童中汇总特异度为91％；T-SPOT.TB在确诊结核病和(或)临床诊断结核病患儿中的汇总敏感度为57％,在对照儿童中汇总特异度为88％；PPD试验在确诊结核病和(或)临床诊断结核病患儿中的汇总敏感度为70％,在对照儿童中汇总特异度为43％.结论 PPD试验因受卡介苗接种的影响,特异度较低；而干扰素γ释放试验因不受卡介苗接种的影响而具有很高的特异度.干扰素γ释放试验可以有效筛查儿童潜伏结核感染,特别是在有卡介苗接种史及活动性密切接触史儿童中.%Objective To evaluate the role of interferon-7 release assays and Tuberculin Skin Test(TST)in diagnosis of pediatric tuberculosis. Methods We searched databases (PUBMED, MEDLINE, OVID, CNKI) between January 1990 and February 2011, performing manual searches of the references from relevant articles and corresponding with the authors of some articles for complete information. Results For QuantiFERON-TB Gold In-Tube, the pooled sensitivity was low in active tuberculosis, 67%(95%CI, 62%-72%)for sensitivity, 91%(95%CI, 86%-95%)for specificity. For T-SPOT.TB, the pooled sensitivity was 57%(95%CI, 53%-62%)and the pooled specificity was high, 88%(95% CI, 84%-91%).For TST, the pooled sensitivity and specificity were both low (70% vs 43%) , especially in BCG vaccinated children(38%). Conclusion Sensitivities of the 3 tests are lower than those in adults, while IGRA is clinically useful to confirm or refute a positive TST result in children in areas with a high incidence of BCG vaccination or non tuberculous mycobacteria (NTM) infection where TST has low positive predictive value.