CAJ | 학술논문

目的：以结核菌素试验为参考标准，系统评价γ干扰素释放试验在诊断实体器官移植术前患者潜伏结核感染的临床价值。方法计算机检索 PubMed、EMBASE、Cochrane 图书馆，检索时间为建库至2012年8月，全面收集γ干扰素释放试验诊断实体器官移植术前患者潜伏结核感染的研究。用Meta Disc 1．4软件对其合并的特异度、敏感度、阴性似然比、阳性似然比等进行分析，绘制综合受试者工作特征曲线。结果最终纳入6个包括QFT-IT试验和T-SPOT试验的γ干扰素释放试验的研究。 QFT-IT试验和T-SPOT 试验对实体器官移植术前患者潜伏结核感染的诊断价值的合并特异度、合并敏感度、合并阳性似然比、合并阴性似然比、合并诊断比值比及综合受试者工作特征曲线下面积分别为81％、74％、3．94、0．33、12．44、0．8478和78％、75％、3．61、0．32、12．07、0．8450。结论经综合受试者工作特征曲线证实，γ干扰素释放试验在实体器官移植术前患者潜伏结核感染诊断中，不适用于结核感染的筛查，也不适合进一步鉴别诊断移植术前患者是否处于潜伏结核，上述结果尚需更多科学的、设计严谨的临床试验进一步证实。
목적：이결핵균소시험위삼고표준，계통평개γ간우소석방시험재진단실체기관이식술전환자잠복결핵감염적림상개치。방법계산궤검색 PubMed、EMBASE、Cochrane 도서관，검색시간위건고지2012년8월，전면수집γ간우소석방시험진단실체기관이식술전환자잠복결핵감염적연구。용Meta Disc 1．4연건대기합병적특이도、민감도、음성사연비、양성사연비등진행분석，회제종합수시자공작특정곡선。결과최종납입6개포괄QFT-IT시험화T-SPOT시험적γ간우소석방시험적연구。 QFT-IT시험화T-SPOT 시험대실체기관이식술전환자잠복결핵감염적진단개치적합병특이도、합병민감도、합병양성사연비、합병음성사연비、합병진단비치비급종합수시자공작특정곡선하면적분별위81％、74％、3．94、0．33、12．44、0．8478화78％、75％、3．61、0．32、12．07、0．8450。결론경종합수시자공작특정곡선증실，γ간우소석방시험재실체기관이식술전환자잠복결핵감염진단중，불괄용우결핵감염적사사，야불괄합진일보감별진단이식술전환자시부처우잠복결핵，상술결과상수경다과학적、설계엄근적림상시험진일보증실。
Objective To assess the diagnostic value of IGRA for latent tuberculosis infection in solid organ transplant recipients. Methods We searched PubMed,EMBASE and Cochrane library to evaluate the evidence of using QuantiFERON-TB Gold in-tube ( QFT-IT ) and T-SPOT on blood for the diagnosis of latent tuberculosis infection in solid organ transplant recipients. Meta Disc 1.4 was used to handle data from included studies. Results The search identified 6 eligible studies that included 751 transplant recipients before transplantation. Compared with TST , the summary values of specificity , sensitivity , positive likelihood ratio , negative likelihood ratio , OR , and SROC curve of QFT-IT and T-SPOT were 81%,74%,3.94,0.33,12.44,0.847 8 and 78%,75%,3.61,0.32,12.07,0.845 0, respectively. Conclusion IGRA in their current formulations has limited accuracy in diagnosing latent tuberculosis infection in transplant recipients , and should not be used alone to rule out or rule in latent tuberculosis infection in transplant recipients. Further modification is needed to improve their accuracy.