γ干扰素释放试验检测诊断类风湿关节炎患者潜伏性结核感染价值的荟萃分析
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摘要
目的通过Meta分析系统评价在类风湿关节炎(RA)患者中γ干扰素释放试验(IGRAs)用于快速检测潜伏性结核感染的诊断价值。方法按照系统评价的要求检索Medline、Pub Med、EMBASE、万方医学网、中国期刊全文数据库(CNKI),获得关于IGRAs试验诊断RA患者中潜伏性结核感染的临床文献,对其进行Meta分析。结果纳入文献共19篇(患者共4789例),卡介苗(BCG)接种率范围(2.8%~83%),T细胞斑点检测(T-SPOT.TB)与结核菌素皮肤试验(TST)优势比(OR)为1.96(95%CI:1.65~2.33,P<0.05),潜伏性结核感染诊断(QFT)与TST的OR为1.38(95%CI:1.20~1.60,P<0.05),QFT与T-SPOT.TB的OR为1.39(95%CI:0.98~1.97,P>0.05)。结论 TST试验因受BCG接种的影响,诊断效能较低,IGRAs方法可避免BCG接种的影响,因此,在RA患者中可以使用IGRAs方法更确切的诊断潜伏结核患者,本试验的资料有限还需更多的临床资料的验证。
Objective To assess the diagnostic value of T-SPOT.TB for latent tuberculosis infection CNKI,in in The patients and with rheumatoid library arthritis(AR)by a systematic review.Methods using The database PubMed,EMBASE,Medline,VIP Cochrane patients.were searched search to evaluate the evidence of T-SPOT.TB 4789 for diagnosis of latent tuberculosis rate infection RA Results T-The identified was 19 eligible studies including patients.BCG coverage was 2.8%-83%.Odds ratio of SPOT.TB vs TST QFT 1.96(95%CI:1.65~2.33,P<0.05),the Odds ratio of QFT vs TST was 1.38(95%CI:1.20~1.60,P<0.05),the Odds low,ratio but of vs T-SPOT.TB could was avoid 1.39(95%CI:0.98~1.97,the P>0.05).Conclusion The effect of BCG vaccination on TST test is TB theT-SPOT.TB infection impact of BCG the vaccination.Thus,be the T-SPOT.TB further is effective in diagnostic latent studies.tuberculosis in patients with RA.However,results need to confirmed by large scale high quality
Objective To assess the diagnostic value of T-SPOT.TB for latent tuberculosis infection CNKI,in in The patients and with rheumatoid library arthritis(AR)by a systematic review.Methods using The database PubMed,EMBASE,Medline,VIP Cochrane patients.were searched search to evaluate the evidence of T-SPOT.TB 4789 for diagnosis of latent tuberculosis rate infection RA Results T-The identified was 19 eligible studies including patients.BCG coverage was 2.8%-83%.Odds ratio of SPOT.TB vs TST QFT 1.96(95%CI:1.65~2.33,P<0.05),the Odds ratio of QFT vs TST was 1.38(95%CI:1.20~1.60,P<0.05),the Odds low,ratio but of vs T-SPOT.TB could was avoid 1.39(95%CI:0.98~1.97,the P>0.05).Conclusion The effect of BCG vaccination on TST test is TB theT-SPOT.TB infection impact of BCG the vaccination.Thus,be the T-SPOT.TB further is effective in diagnostic latent studies.tuberculosis in patients with RA.However,results need to confirmed by large scale high quality
引文
[1]Behar SM,Shin DS,Maier A,et al.Use of the T-SPOT.TB assay to detect latent tuberculosis infection among rheumatic disease patients on immunosuppressive therapy[J].The Journal of rheumatology,2009,36(3):546-551.
[2]Solovic I,Sester M,Gomez-Reino JJ,et al.The risk of tuberculosis related to tumour necrosis factor antagonist therapies:a TBNETconsensus statement[J].European Respiratory Journal,2010,36(5):1185-1206.
[3]LiotéH,LiotéF.Role for interferon-gamma release assays in latent tuberculosis screening before TNF-αantagonist therapy[J].Joint Bone Spine,2011,78(4):352-357.
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[7]Whiting P,Rutjes AWS,Reitsma JB,et al.The development of QUADAS:a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews[J].BMC medical research methodology,2003,3(1):25.
[8]Arslanso Camlar,Makay B,Appak O,et al.Performance of tuberculin skin test and interferon gamma assay for the diagnosis of latent tuberculosis infection in juvenile idiopathic arthritis[J].Clinical Rheumatology,2011,30(9):1189-1193.
[9]Chang B,Park H Y,Jeon K,et al.Interferon-γrelease assay in the diagnosis of latent tuberculosis infection in arthritis patients treated with tumor necrosis factor antagonists in Korea[J].Clinical Rheumatology,2011,30(12):1535-1541.
[10]Costantino F,De CBM,Rat AC,et al.Screening for latent tuberculosis infection in patients with chronic inflammatory arthritis:discrepancies between tuberculin skin test and interferon-γrelease assay results[J].Journal of Rheumatology,2013,40(12):1986-1993.
[11]Silvaa Daniela GST,Torres PP,Junior PJS,et al.Latent Tuberculosis in Rheumatoid Arthritis:Evaluating Cellular Response and High-Resolution Computed Tomography[J].Archivos De Br-onconeumolog a,2012,48(5):144-149.
[12]Hatemi G,Melikoglu M,Ozbakir F,et al.Quantiferon-TB Gold in tube assay for the screening of tuberculosis before and during treatment with tumor necrosis factor alpha antagonists[J].Arthritis Research&Therapy,2012,14(3):R147-R147.
[13]Hsia EC,Schluger N,Cush JJ,et al.Interferon-γrelease assay versus tuberculin skin test prior to treatment with golimumab,a human anti-tumor necrosis factor antibody,in patients with rheumatoid arthritis,psoriatic arthritis,or ankylosing spo-ndylitis[J].Arthritis&Rheumatism,2012,64(7):2068-2077.
[14]Martin J,Cgibbs W.Comparison of interferon gamma release assays and conventional screening tests before tumour necrosis factor alpha blockade in patients with inflammatory arthritis[J].Annals of the Rheumatic Diseases,2010,69(01):181.
[15]Greenberg JEFFREYD,Reddy SM,Schloss SG,et al.Comparison of an in vitro tuberculosis interferon-gamma assay with delayedtype hypersensitivity testing for detection of latent Mycobacterium tuberculosis:a pilot study in rheumatoid arthritis[J].Journal of Rheumatology,2008,35(5):770.
[16]Jeongha P,Gayoung S,Jinsook L,et al.Positive conversion of tuberculin skin test and performance of interferon release assay to detect hidden tuberculosis infection during anti-tumor necrosis factor agent trial[J].Journal of Rheumatology,2009,36(10):2158-63.
[17]Leon D,Acevedovasquez E,Alvizuri S,et al.Comparison of an interferon-gamma assay with tuberculin skin testing for detection of tuberculosis(TB)infection in patients with rheumatoid arthritis in a TB-endemic population[J].Journal of Rheumatology,2008,35(5):776-81.
[18]Bocchino M,Matarese A,Bellofiore B,et al.Performance of two commercial blood IFN-γrelease assays for the detection of Mycobacterium tuberculosis,infection in patient candidates for anti-TNF-αtreatment[J].European Journal of Clinical Microbiology&Infectious Diseases,2008,27(10):907.
[19]Murakami S,Takeno M,Kirino Y,et al.Screening of tuberculosis by interferon-γassay before biologic therapy for rheumatoid arthritis[J].Tuberculosis,2009,89(2):136-141.
[20]Sang KL,Song YK,Kim EY,et al.Mycobacterial Infections in Patients Treated with Tumor Necrosis Factor Antagonists in South Korea[J].Lung,2013,191(5):565-571.
[21]Vassilopoulos D,Stamoulis N E,Archimandritis A.Usefulness of enzyme-linked immunospot assay(elispot)compared to tuberculin skin testing for latent tuberculosis screening in rheumatic patients scheduled for anti-tumor necrosis factor treatment[J].Journal of Rheumatology,2008,35(7):1271-1276.
[22]Mariette X,Baron G,Tubach F,et al.Influence of replacing tuberculin skin test with ex vivo interferonγrelease assays on decision to administer prophylactic antituberculosis antibiotics before anti-TNF therapy[J].Annals of the Rheumatic Diseases,2012,71(11):1783.
[23]Matulis G,Jüni P,Villiger P M,et al.Detection of latent tuberculosis in immunosuppressed patients with autoimmune diseases:performance of a Mycobacterium tuberculosis antigenspecific interferon gamma assay[J].Annals of the Rheumatic Dis-eases,2008,67(1):84.
[24]乌玛.T-SPOT.TB在评估系统性自身免疫病合并结核病患者中的作用研究[D].中南大学,2012.
[25]裘昊旻,金嘉琳,张舒,等.T细胞酶联免疫斑点法对风湿性疾病患者潜伏性结核感染诊断价值的初步研究[J].中华风湿病学杂志,2009,13(5):313-315.
[26]胥魏,高恺言,袁风红,等.结核感染T细胞斑点试验在风湿性疾病潜伏性结核筛检中的应用[J].中外医学研究,2010,08(26):28-30.
[27]Lee JY,Choi HJ,Park IN,et al.Comparison of two commercial interferon-γassays for diagnosing Mycobacterium tuberculosis infection[J].European Respiratory Journal,2006,28(1):24-30.
[28]Richeldi L.An update on the diagnosis of tuberculosis infection[J].American journal of respiratory and critical care medicine,2006,174(7):736-742.
[29]Wang L,Turner MO,Elwood RK,et al.A meta-analysis of the effect of Bacille Calmette Guerin vaccination on tuberculin skin test measurements[J].Thorax,2002,57(9):804-809.
[30]Park JH,Seo GY,Lee JS,et al.Positive conversion of tuberculin skin test and performance of interferon release assay to detect hidden tuberculosis infection during anti-tumor necrosis factor agent trial[J].The Journal of rheumatology,2009,36(10):2158-2163.
[31]Marques CDL,DuarteA LBP,de Lorena VMB,et al.Evaluation of an interferon gamma assay in the diagnosis of latent tuberculosis infection in patients with rheumatoid arthritis[J].Rheumatology international,2009,30(1):57-62.
[32]Emery P,Panayi G,Symmons D,et al.Mechanisms of depressed delayed-type hypersensitivity in rheumatoid arthritis:the role of protein energy malnutrition[J].Annals of the rheumatic diseases,1984,43(3):430-434.
[33]Dai Y,Feng Y,Xu R,et al.Evaluation of interferon-gamma release assays for the diagnosis of tuberculosis:an updated meta-analysis[J].European Journal of Clinical Microbiology&In-fectious Diseases,2012,31(11):3127-3137.
[34]Mandalakas AM,Detjen AK,Hesseling AC,et al.Interferongamma release assays and childhood tuberculosis:systematic review and meta-analysis[Review article][J].The International Journal of Tuberculosis and Lung Disease,2011,15(8):1018-1032.
[35]Rogerson TE,Chen S,Kok J,et al.Tests for latent tuberculosis in people with ESRD:a systematic review[J].American Journal of Kidney Diseases,2013,61(1):33-43.
[36]Le Hang NT,Lien LT,Kobayashi N,et al.Analysis of factors lowering sensitivity of interferon-γrelease assay for tuberculosis[J].PloS one,2011,6(8):e23806.
[37]Diel R,Goletti D,Ferrara G,et al.Interferon-γrelease assays for the diagnosis of latent Mycobacterium tuberculosis infection:a systematic review and meta-analysis[J].European Respiratory Journal,2010,37(1):88.
[38]Tang G J,Zhang YL,Department R M,et al.Diagnostic Value of Combined Detection of Pleural Effusion ADA,IL-27 and T-SPOT TB in Tuberculous Pleurisy[J].China&Foreign Medical Treatment,2018,8(2):e35772..
[39]Ran H U,Wang P,Chen Q,et al.Clinical significance of T-SPOT.TB for diagnosis and treatment of tuberculosis in panniculitis patients[J].Journal of Third Military Medical University,2018,4(2):e37492.
[2]Solovic I,Sester M,Gomez-Reino JJ,et al.The risk of tuberculosis related to tumour necrosis factor antagonist therapies:a TBNETconsensus statement[J].European Respiratory Journal,2010,36(5):1185-1206.
[3]LiotéH,LiotéF.Role for interferon-gamma release assays in latent tuberculosis screening before TNF-αantagonist therapy[J].Joint Bone Spine,2011,78(4):352-357.
[4]De Leon D P,Acevedo-Vasquez E,Sanchez-Torres A,et al.Attenuated response to purified protein derivative in patients with rheumatoid arthritis:study in a population with a high prevalence of tuberculosis[J].Annals of the rheumatic diseases,2005,64(9):1360-1361.
[5]Pai M,Zwerling A,Menzies D.Systematic review:T-cell-based assays for the diagnosis of latent tuberculosis infection:an update[J].Annals of internalmedicine,2008,149(3):177-184.
[6]Mori T.Usefulness of interferon-gamma release assays for diagnosing TB infection and problems with these assays[J].Journal of infection and chemotherapy,2009,15(3):143-155.
[7]Whiting P,Rutjes AWS,Reitsma JB,et al.The development of QUADAS:a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews[J].BMC medical research methodology,2003,3(1):25.
[8]Arslanso Camlar,Makay B,Appak O,et al.Performance of tuberculin skin test and interferon gamma assay for the diagnosis of latent tuberculosis infection in juvenile idiopathic arthritis[J].Clinical Rheumatology,2011,30(9):1189-1193.
[9]Chang B,Park H Y,Jeon K,et al.Interferon-γrelease assay in the diagnosis of latent tuberculosis infection in arthritis patients treated with tumor necrosis factor antagonists in Korea[J].Clinical Rheumatology,2011,30(12):1535-1541.
[10]Costantino F,De CBM,Rat AC,et al.Screening for latent tuberculosis infection in patients with chronic inflammatory arthritis:discrepancies between tuberculin skin test and interferon-γrelease assay results[J].Journal of Rheumatology,2013,40(12):1986-1993.
[11]Silvaa Daniela GST,Torres PP,Junior PJS,et al.Latent Tuberculosis in Rheumatoid Arthritis:Evaluating Cellular Response and High-Resolution Computed Tomography[J].Archivos De Br-onconeumolog a,2012,48(5):144-149.
[12]Hatemi G,Melikoglu M,Ozbakir F,et al.Quantiferon-TB Gold in tube assay for the screening of tuberculosis before and during treatment with tumor necrosis factor alpha antagonists[J].Arthritis Research&Therapy,2012,14(3):R147-R147.
[13]Hsia EC,Schluger N,Cush JJ,et al.Interferon-γrelease assay versus tuberculin skin test prior to treatment with golimumab,a human anti-tumor necrosis factor antibody,in patients with rheumatoid arthritis,psoriatic arthritis,or ankylosing spo-ndylitis[J].Arthritis&Rheumatism,2012,64(7):2068-2077.
[14]Martin J,Cgibbs W.Comparison of interferon gamma release assays and conventional screening tests before tumour necrosis factor alpha blockade in patients with inflammatory arthritis[J].Annals of the Rheumatic Diseases,2010,69(01):181.
[15]Greenberg JEFFREYD,Reddy SM,Schloss SG,et al.Comparison of an in vitro tuberculosis interferon-gamma assay with delayedtype hypersensitivity testing for detection of latent Mycobacterium tuberculosis:a pilot study in rheumatoid arthritis[J].Journal of Rheumatology,2008,35(5):770.
[16]Jeongha P,Gayoung S,Jinsook L,et al.Positive conversion of tuberculin skin test and performance of interferon release assay to detect hidden tuberculosis infection during anti-tumor necrosis factor agent trial[J].Journal of Rheumatology,2009,36(10):2158-63.
[17]Leon D,Acevedovasquez E,Alvizuri S,et al.Comparison of an interferon-gamma assay with tuberculin skin testing for detection of tuberculosis(TB)infection in patients with rheumatoid arthritis in a TB-endemic population[J].Journal of Rheumatology,2008,35(5):776-81.
[18]Bocchino M,Matarese A,Bellofiore B,et al.Performance of two commercial blood IFN-γrelease assays for the detection of Mycobacterium tuberculosis,infection in patient candidates for anti-TNF-αtreatment[J].European Journal of Clinical Microbiology&Infectious Diseases,2008,27(10):907.
[19]Murakami S,Takeno M,Kirino Y,et al.Screening of tuberculosis by interferon-γassay before biologic therapy for rheumatoid arthritis[J].Tuberculosis,2009,89(2):136-141.
[20]Sang KL,Song YK,Kim EY,et al.Mycobacterial Infections in Patients Treated with Tumor Necrosis Factor Antagonists in South Korea[J].Lung,2013,191(5):565-571.
[21]Vassilopoulos D,Stamoulis N E,Archimandritis A.Usefulness of enzyme-linked immunospot assay(elispot)compared to tuberculin skin testing for latent tuberculosis screening in rheumatic patients scheduled for anti-tumor necrosis factor treatment[J].Journal of Rheumatology,2008,35(7):1271-1276.
[22]Mariette X,Baron G,Tubach F,et al.Influence of replacing tuberculin skin test with ex vivo interferonγrelease assays on decision to administer prophylactic antituberculosis antibiotics before anti-TNF therapy[J].Annals of the Rheumatic Diseases,2012,71(11):1783.
[23]Matulis G,Jüni P,Villiger P M,et al.Detection of latent tuberculosis in immunosuppressed patients with autoimmune diseases:performance of a Mycobacterium tuberculosis antigenspecific interferon gamma assay[J].Annals of the Rheumatic Dis-eases,2008,67(1):84.
[24]乌玛.T-SPOT.TB在评估系统性自身免疫病合并结核病患者中的作用研究[D].中南大学,2012.
[25]裘昊旻,金嘉琳,张舒,等.T细胞酶联免疫斑点法对风湿性疾病患者潜伏性结核感染诊断价值的初步研究[J].中华风湿病学杂志,2009,13(5):313-315.
[26]胥魏,高恺言,袁风红,等.结核感染T细胞斑点试验在风湿性疾病潜伏性结核筛检中的应用[J].中外医学研究,2010,08(26):28-30.
[27]Lee JY,Choi HJ,Park IN,et al.Comparison of two commercial interferon-γassays for diagnosing Mycobacterium tuberculosis infection[J].European Respiratory Journal,2006,28(1):24-30.
[28]Richeldi L.An update on the diagnosis of tuberculosis infection[J].American journal of respiratory and critical care medicine,2006,174(7):736-742.
[29]Wang L,Turner MO,Elwood RK,et al.A meta-analysis of the effect of Bacille Calmette Guerin vaccination on tuberculin skin test measurements[J].Thorax,2002,57(9):804-809.
[30]Park JH,Seo GY,Lee JS,et al.Positive conversion of tuberculin skin test and performance of interferon release assay to detect hidden tuberculosis infection during anti-tumor necrosis factor agent trial[J].The Journal of rheumatology,2009,36(10):2158-2163.
[31]Marques CDL,DuarteA LBP,de Lorena VMB,et al.Evaluation of an interferon gamma assay in the diagnosis of latent tuberculosis infection in patients with rheumatoid arthritis[J].Rheumatology international,2009,30(1):57-62.
[32]Emery P,Panayi G,Symmons D,et al.Mechanisms of depressed delayed-type hypersensitivity in rheumatoid arthritis:the role of protein energy malnutrition[J].Annals of the rheumatic diseases,1984,43(3):430-434.
[33]Dai Y,Feng Y,Xu R,et al.Evaluation of interferon-gamma release assays for the diagnosis of tuberculosis:an updated meta-analysis[J].European Journal of Clinical Microbiology&In-fectious Diseases,2012,31(11):3127-3137.
[34]Mandalakas AM,Detjen AK,Hesseling AC,et al.Interferongamma release assays and childhood tuberculosis:systematic review and meta-analysis[Review article][J].The International Journal of Tuberculosis and Lung Disease,2011,15(8):1018-1032.
[35]Rogerson TE,Chen S,Kok J,et al.Tests for latent tuberculosis in people with ESRD:a systematic review[J].American Journal of Kidney Diseases,2013,61(1):33-43.
[36]Le Hang NT,Lien LT,Kobayashi N,et al.Analysis of factors lowering sensitivity of interferon-γrelease assay for tuberculosis[J].PloS one,2011,6(8):e23806.
[37]Diel R,Goletti D,Ferrara G,et al.Interferon-γrelease assays for the diagnosis of latent Mycobacterium tuberculosis infection:a systematic review and meta-analysis[J].European Respiratory Journal,2010,37(1):88.
[38]Tang G J,Zhang YL,Department R M,et al.Diagnostic Value of Combined Detection of Pleural Effusion ADA,IL-27 and T-SPOT TB in Tuberculous Pleurisy[J].China&Foreign Medical Treatment,2018,8(2):e35772..
[39]Ran H U,Wang P,Chen Q,et al.Clinical significance of T-SPOT.TB for diagnosis and treatment of tuberculosis in panniculitis patients[J].Journal of Third Military Medical University,2018,4(2):e37492.