外周血结核感染T细胞斑点试验对脊柱结核诊断价值的Meta分析

doi:10.3969/j.issn.1000-6621.2019.10.004

摘要/Abstract

摘要：

目的系统评价外周血结核感染T细胞斑点试验(T-cell spot of tuberculosis,T-SPOT.TB)在脊柱结核诊断中的应用价值。方法通过计算机检索中国知网、万方、维普、PubMed、EMBASE、Cochrane Library等数据库,获得以T-SPOT.TB诊断脊柱结核的相关文献,检索起止时间为建库至2019年6月。由2名研究者独立进行文献检索、筛选、数据提取,质量评价,以MetaDisc 1.4 软件进行Meta分析。结果共检索出219篇文献,依据纳入和排除标准最终纳入8篇文献。外周血T-SPOT.TB诊断脊柱结核的汇总敏感度为88.0%(95%CI:85.0%~91.0%),汇总特异度为90.0%(95%CI:86.0%~93.0%),汇总阳性似然比为8.67(95%CI:6.47~11.62),汇总阴性似然比为0.13(95%CI:0.10~0.16),汇总诊断OR值为63.14(95%CI:42.14~94.60),汇总受试者工作特征曲线下面积为0.95。结论外周血T-SPOT.TB对脊柱结核具有较高的诊断价值,可作为快速诊断脊柱结核的有效方法。

关键词: 结核, 脊柱, 酶联免疫斑点检测, 诊断, Meta分析, γ干扰素释放试验

Abstract:

Objective To systematically review the diagnostic value of the T-SPOT.TB test of peripheral blood for diagnosing spinal tuberculosis.Methods All literatures involved the diagnostic value of the T-SPOT.TB test of peripheral blood for diagnosing spinal tuberculosis which published from establishment to June 2019 were identified from CNKI, WanFang Data, VIP, PubMed, EMBASE, Cochrane Library, etc. Two researchers independently conducted literature search, screened the literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of included studies. MetaDisc 1.4 were used to conduct the meta-analysis.Results A total of 219 articles were retrieved and 8 articles were eventually included based on inclusion and exclusion criteria. The cumulative sensitivity of peripheral blood T-SPOT.TB test for the diagnosis of spinal tuberculosis was 88.0% (95%CI: 85.0% to 91.0%), and the specificity (SPE) was 90.0% (95%CI:86.0%-93.0%), the positive likelihood ratio (PLR) was 8.67 (95%CI:6.47-11.62), the negative likelihood ratio (NLR) was 0.13 (95%CI:0.10-0.16),the diagnosis odds ratio (OR) was 63.14 (95%CI:42.14-94.60), and the area under the curve (AUC) of summary receiver operating characteristics (SROC) was 0.95.Conclusion T-SPOT.TB test of peripheral blood plays a valuable role in the diagnosis of spinal tuberculosis and can be used as an effective method for rapid diagnosis of spinal tuberculosis.

Key words: Tuberculosis, spinal, Enzyme-linked immunospot assay, Diagnosis, Meta-analysis, Interferon gamma release assay

姚利,盛健,王冰,戴希勇. 外周血结核感染T细胞斑点试验对脊柱结核诊断价值的Meta分析[J]. 中国防痨杂志, 2019, 41(10): 1084-1089. doi: 10.3969/j.issn.1000-6621.2019.10.004

Li YAO,Jian SHENG,Bing WANG,Xi-yong DAI. Meta-analysis of T-SPOT.TB test for diagnosing spinal tuberculosis[J]. Chinese Journal of Antituberculosis, 2019, 41(10): 1084-1089. doi: 10.3969/j.issn.1000-6621.2019.10.004

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作者	发表年限	结核/非结核患者(例)	诊断标准	TP (例)	FP (例)	FN (例)	TN (例)	QUADAS评分 (分)
Yuan等^[5]	2013	29/32	病原/病理	24	6	5	26	12
李宝田等^[6]	2015	68/42	临床/病原/病理	62	4	6	38	10
汪锴等^[7]	2018	62/36	临床/病原/病理	58	3	4	33	10
杨雪梅等^[8]	2018	50/37	临床/病原/病理	41	3	9	34	11
刘汉辉等^[9]	2017	50/50	病原/病理	44	3	6	47	13
地里下提等^[10]	2014	112/44	临床/病原/病理	96	6	16	38	10
华裕忠等^[11]	2016	122/86	病原/病理	105	10	17	76	12
程红燕等^[12]	2017	98/77	临床/病原/病理	92	6	6	71	11