γ-干扰素释放试验在鉴别肠结核与克罗恩病临床价值的系统评价

Clinical value of interferon-γ releasing assay in differentiating intestinal tuberculosis and Crohn’s disease：a systematic review

摘要:

目的：系统评价2种不同γ-干扰素释放试验（interferon-γ releasing assay，IGRA）对鉴别肠结核（intestinal tuberculosis，ITB）和克罗恩病（Crohn’s disease，CD）的诊断价值。方法：计算机检索Embase、PubMed、EBM Reviews、中国期刊全文数据库（CNKI）、万方数字化期刊全文数据库，查找评价IGRA在ITB与CD鉴别诊断价值的文献，对纳入的文献进行质量评价，采用Meta-Disc 1.4软件进行Meta分析，分别汇总2种IGRA的敏感度、特异度及95%可信性区间（95% confidence interval，95%CI）。根据汇总受试者工作特征曲线（summery reciever operating characteristic，SROC），计算曲线下面积（area under curve，AUC），得出各自的Q*值，评价不同方法的诊断价值。结果：共纳入12篇文献，总病例数854例（ITB 367例，CD 487例）。结核感染T淋巴细胞斑点试验（T-SPOT.TB）的汇总敏感度和特异度分别为0.89（95%CI=0.84～0.93）、0.85（95%CI=0.81～0.89）。结核杆菌T淋巴细胞检测（QuantiFeron-TB）的汇总敏感度和特异度分别为0.72（95%CI=0.64～0.79）、0.92（95%CI=0.86～0.96）。2组的SROC曲线下面积分别为0.9450、0.9110。两者Q*值分别为0.8839、0.8432，比较2组Q*值，差异无统计学意义（P=0.164）。结论：T-SPOT与QuantiFeron-TB是鉴别ITB与CD的有效辅助手段，两者诊断准确性差异无统计学意义。

Abstract:

Objective：To evaluate the value of two interferon-γ releasing assays（IGRA） in differential diagnosis of intestinal tubercu－losis（ITB） and Crohn’s disease（CD）. Methods：Datebases of Embase，PubMed，EBM Reviews，CNKI，WanFang were searched for evaluating the value of IGRA in differential diagnosis of ITB and CD. The Meta-Disc was used to calculate the pooled sensitivity，specificity and 95% confidence interval（95%CI）. Summary receiver operating characteristic curve（SROC），area under curve（AUC） and Q* were used to evaluate the efficiency of the two methods. Results：Totally 12 articles were included，including 854 patients（ITB 367，CD 487）. The pooled sensitivity and specificity for T-SPOT TB were 0.89（95%CI=0.84 to 0.93） and 0.85（95%CI＝0.81 to 0.89）. The pooled sensitivity and specificity for Quantiferon-TB were 0.72（95%CI=0.64 to 0.79） and 0.92（95%CI=0.86 to 0.96）. The AUC of SROC for the two methods were 0.9450 and 0.9110，and the Q* were 0.883 9 and 0.843 2. There was no statistically difference between the two methods（P=0.164）. Conclusion：T-SPOT.TB and Quantiferon-TB are both effective ways for the differ－ential diagnosis of ITB and CD. But there was no statistically difference between the two methods.