LANCET INFECT DIS:现有和第二代干扰素-γ释放试验的临床应用?

2019-02-02 MedSci MedSci原创

尽管干扰素-γ释放试验(IGRAs)常用于结核病发病率低的国家,但它们在诊断活动性结核病中的临床应用尚不清楚。本研究旨在在低发病率环境中,通过确定商业可用和第二代IGRAs对疑似结核病的诊断评估的准确性和实用性来解决这种临床不确定性。 <span style="font-family:宋体;mso-ascii-font-family:Calibri; mso-ascii-theme-fon

尽管干扰素-γ释放试验(IGRAs)常用于结核病发病率低的国家,但它们在诊断活动性结核病中的临床应用尚不清楚。本研究旨在在低发病率环境中,通过确定商业可用和第二代IGRAs对疑似结核病的诊断评估的准确性和实用性来解决这种临床不确定性。

研究人员对英格兰常规二级保健中疑似肺结核的成年人进行了一项前瞻性队列研究。对患者进行结核分枝杆菌感染基线检测(t)。采用TBQuantiFERON-TB Gold in tube [QFT-GIT])和第二代(纳入新的M结核抗原)IGRAs,并随访6 - 12个月确定最终诊断。确定了测试的灵敏度,特异性,阳性和阴性似然比以及预测值。

研究发现,在参加该研究的1060名成年人中,共纳入845人分析,363人被诊断患有结核病。T-SPOT的灵敏度对TB所有结核病诊断,包括培养证实的和很可能发生的情况下,为81.4%(95CI 76.6-85.3),比QFT-GIT高(67.3[62.0- 72.1])。对于培养证实的结核病,第二代IGRAs的敏感性为94.0%(90.0-96.4),当包含高度可能的结核病时,敏感性为89.2%(85.2-92.2),所有结核病例的比例为0.1395CI 0.10-0.19)。T-SPOT的特异性范围为86.2%(95CI 82.3-89.4)。 TB80.0%(75.6-83.8),适用于第二代IGRAs

研究表明,商业化IGRAs对于疑似结核病的诊断评估准确性不够。然而,第二代测试可能具有足够高的灵敏度,低阴性似然比,并且在低发病率环境中具有相应高的阴性预测值,可以便于迅速排除结核病。

原始出处:

evaluation of tuberculosis, Clinical utility of existing and second-generation interferon-γ release assays for diagnostic

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    2019-10-21 howi
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    2019-02-28 cmj8wellington
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    2019-02-06 lietome24

    好文,值得点赞!认真学习了,把经验应用于实践,为患者解除病痛。

    0