摘要目的 通过Meta分析综合目前为止国内外发表和未发表的相关研究,以评估γ干扰素释放分析(IGRAs)对克罗恩病和肠结核鉴别诊断的价值.方法 系统检索国内外主要的电子文献数据库,筛选评估IGRAs对肠结核和克罗恩病鉴别诊断价值的研究,计算的主要参数为敏感性、特异性、阳性似然比(PLR)和阴性似然比(NLR),并进行效应量合并,计算综合接受者操作特征(sROC)曲线的曲线下面积(AUC)来评估总的准确性.结果 经过筛选,共纳入12篇原始文献(均来自亚洲国家).计算IGRAs对于鉴别ITB和CD的总敏感性和特异性,分别为82.8％ (95％ CI 78.4％ ～86.6％)和86.7％(95％ CI 83.2％～89.6％);总的阳性似然比(PLR)和阴性似然比(NLR)分别为6.870(95％CI5.345～8.830)和0.171 (95％ CI0.105～0.279);总的诊断比值比(DOR)为44.030(95％CI27.964～69.325).sROC曲线的AUC值为0.939.结论 IGRAs对诊断肠结核有很好的敏感性和特异性,且诊断特异性的一致性较好.在鉴别肠结核和克罗恩病时,IGRAs可作为一个重要的补充诊断工具.

abstractsObjective This meta-analysis assessed the value of interferon-γ release assays (IGRAs) in the differential diagnosis of intestinal tuberculosis (ITB) from Crohn's disease (CD).Methods Systematic search without language restriction was conducted in the main computerized databases until June 2015.Studies that have evaluated the performance of IGRAs (QuantiFERON-TB Gold or T-SPOT.TB) in distinguishing ITB from CD were eligible.Main outcome measures included sensitivity and specificity.Area under the curve (AUC) of the summary receiver operating characteristic (sROC) curve was used to evaluate the accuracy of IGRAs.Results Twelve studies (all from Asia) were finally included.The pooled sensitivity and specificity of IGRAs for the differential diagnosis of ITB from CD were 82.8％ (95％CI 78.4％-86.6％) and 86.7％ (95％ CI 83.2％-89.6％) respectively.The positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 6.870 (95％ CI 5.345-8.830) and 0.171 (95％ CI 0.105-0.279).The diagnostic odds ratio was 44.030 (95％ CI 27.964-69.325).And the AUC of sROC was 0.939.Conclusions IGRAs have a high sensitivity and specificity for the diagnosis of ITB,and specificity is consistent from study to study.IGRAs may be considered as a supplementary method in the differential diagnosis of ITB from CD.