γ-干扰素释放试验诊断成人肺外结核准确性的系统综述与荟萃分析OA

Objective:To systematically evaluate the diagnostic accuracy of interferon-γ release assays(IGRA)for extrapulmonary tuberculosis(EPTB)in adults across different specimen types and assay methods,and to provide evidence-based guidance for optimizing clinical diagnostic pathways.Methods:A systematic search was conducted across PubMed,Web of Science,and the Cochrane Library databases from January 2014 to May 2025,to identify studies comparing the diagnostic accuracy of commercial IGRA(T-SPOT.TB or QuantiFERON-TB Gold series)with composite reference standards(culture and/or clinical diagnosis).Bivariate random effect models were used to combine sensitivity and specificity,and subgroup analyses(specimen type,detection method,disease type,etc.)and meta-regression were conducted.Results:A total of 28 studies(32 573 participants)were included.The overall pooled sensitivity,specificity,and area under curve(AUC)values were 0.83(95％CI:0.79-0.87),0.86(95％CI:0.82-0.90),and 0.9089,respectively.The sensitivity of IGRA for detecting body fluid samples was comparable to that of blood samples(0.86 vs.0.84),but the specificity was higher(0.92 vs.0.81).The enzyme-linked immunospot assay(ELISPOT)demonstrated superior specificity compared to the enzyme-linked immunosorbent assay(ELISA)(0.86 vs.0.81).For tuberculous pleurisy,the AUC value of pleural effusion ELISPOT detection was 0.972,which was superior to that of blood detection(AUC=0.909).Blood ELISPOT detection showed good diagnostic performance in the lymph node tuberculosis subgroup(AUC=0.936).IGRA had limited diagnostic value for osteoarticular tuberculosis(AUC=0.734).Conclusion:IGRA is an effective auxiliary tool for diagnosing EPTB,but its detection performance depends on the type of specimen and the detection method.Evidence suggests that for patients suspected of having tuberculous pleurisy,pleural effusion ELISPOT testing should be prioritized,while for lymph node tuberculosis,blood ELISPOT testing should be preferred.In the diagnosis of osteoarticular tuberculosis,IGRA results should be interpreted with caution.