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目的系统评价结核感染T细胞酶联免疫斑点试验(T-SPOT.TB)在结核诊断中的价值。方法通过计算机检索CNKI、万方、维普、生物医学文献数据库、PubMed等数据库,获得关于T-SPOT.TB诊断结核的诊断性试验的文献,提取四格表等信息,采用MetaDisc1.4和Stata12.0软件进行统计学分析。结果共9篇文献纳入,各研究间存在明显阈值效应引起的异质性,拟合SROC曲线,计算AUC=0.95,Q指数为0.89。试剂盒来源是引起阈值效应的可能原因,以Oxford(UK)提供的试剂盒为亚组进行分析,汇总灵敏度和特异度分别为0.91[95%CI(0.87-0.94)],0.91[95%CI(0.87-0.94)],阳性似然比和阴性似然比分别为11.09[95%CI(7.12-17.28)]和0.10[95%CI(0.07-0.15)],诊断比值比(OR)为110.97[95%CI(57.67-213.52)];合并均无显著异质性(I2均<50%,P均>0.05)。Begg’s检验发现不存在发表偏倚。结论T-SPOT.TB对诊断结核有较高的诊断效能,可以帮助临床实践。
Objective To evaluate the value of T-SPOT.TB in the diagnosis of tuberculosis. Methods The databases of CNKI, Wanfang, VIP, Biomedical Literature Database and PubMed were searched by computer to get the literature about the diagnostic test of T-SPOT.TB diagnostic tuberculosis. The information of four-cell table was extracted, and MetaDisc 1.4 and Stata12 were used. 0 software for statistical analysis. Results A total of 9 articles were included. There was a heterogeneity caused by the obvious threshold effect among all the studies. The SROC curve was fitted to calculate the AUC of 0.95 and the Q-index of 0.89. The source of the kit was a possible cause of the threshold effect. The kit was sub-analyzed in a kit supplied by Oxford (UK) with a combined sensitivity and specificity of 0.91 [95% CI (0.87-0.94)], 0.91 [95% CI (0.87-0.94)], positive likelihood ratios and negative likelihood ratios were 11.09 [95% CI (7.12-17.28)] and 0.10 [95% CI 0.07-0.15], respectively. The odds ratio was 110.97 [95% CI (57.67-213.52)]. No significant heterogeneity was found in the combined groups (all <50%, all P> 0.05). Begg’s test found no publication bias. Conclusion T-SPOT.TB has high diagnostic efficacy in diagnosing tuberculosis and can help clinical practice.