CAJ | 학술논문

目的系统评价抗α-胞衬蛋白抗体对干燥综合征(SS)的诊断价值.方法检索1997年1月至2007年12月Cochrane图书馆、Medline、Embase和中国生物医学文献数据库等数据库,按照Cochrane协作网推荐的诊断试验的纳入标准筛选文献,采用QUADAS工具评价纳入文献质量,应用MATLAB软件、Review Manager 4.2软件及Meta.Disc 1.4软件对纳入研究进行综合定量评价,分析异质性来源及绘制综合受试者工作曲线(SROC).结果共纳入18个中英文研究均检测抗α-胞衬蛋白IgG类抗体,合并敏感性为0.40[95%CI(0.37～0.43)],合并特异性为0.82[95%ct(0.79～0.84)],SROC下面积(AUC)是0.8029,标准误(SE)是0.0580;8个研究检测抗α-胞衬蛋白IgA类抗体,合并敏感性为0.34[95%CI(0.30～0.38)],合并特异性为0.83[95%ci(0.79～0.86)],AUC=0.6374,SE=0.1841;合并数据均有异质性.分别从年龄、人种、实验方法、试剂来源、诊断标准和研究国家进行分层分析,其中来自中国的4个研究和日本的6个研究无异质性,抗α-胞衬蛋白IgG类抗体对sS临床诊断价值SROC分析结果分别为AUC=0.7343,SE=0.0448和AUC=0.9273,SE=0.0394.结论纳入研究存在异质性,诊断标准、试剂来源、实验方法、民族地域和年龄等是异质性的主要来源;综合定量分析结果显示抗α-胞衬蛋白IgG/IgA类抗体对于SS的临床诊断均具有较低的敏感性和较高的特异性,抗体阴性对于临床排除SS诊断意义不大,抗体阳性对于确定Ss诊断可能具有更高的临床价值.
목적 계통평개항α-포츤단백항체대간조종합정(SS)적진단개치.방법 검색1997년1월지2007년12월Cochrane도서관、Medline、Embase화중국생물의학문헌수거고등수거고,안조Cochrane협작망추천적진단시험적납입표준사선문헌,채용QUADAS공구평개납입문헌질량,응용MATLAB연건、Review Manager 4.2연건급Meta.Disc 1.4연건대납입연구진행종합정량평개,분석이질성래원급회제종합수시자공작곡선(SROC).결과 공납입18개중영문연구균검측항α-포츤단백IgG류항체,합병민감성위0.40[95%CI(0.37～0.43)],합병특이성위0.82[95%ct(0.79～0.84)],SROC하면적(AUC)시0.8029,표준오(SE)시0.0580;8개연구검측항α-포츤단백IgA류항체,합병민감성위0.34[95%CI(0.30～0.38)],합병특이성위0.83[95%ci(0.79～0.86)],AUC=0.6374,SE=0.1841;합병수거균유이질성.분별종년령、인충、실험방법 、시제래원、진단표준화연구국가진행분층분석,기중래자중국적4개연구화일본적6개연구무이질성,항α-포츤단백IgG류항체대sS림상진단개치SROC분석결과 분별위AUC=0.7343,SE=0.0448화AUC=0.9273,SE=0.0394.결론 납입연구존재이질성,진단표준、시제래원、실험방법 、민족지역화년령등시이질성적주요래원;종합정량분석결과 현시항α-포츤단백IgG/IgA류항체대우SS적림상진단균구유교저적민감성화교고적특이성,항체음성대우림상배제SS진단의의불대,항체양성대우학정Ss진단가능구유경고적림상개치.
Objective To evaluate the diagnostic accuracy of anti-α-fodrin antibody for Sjogren's syndrome (SS). Methods Qualified literatures on evaluation of anti-ot-fodrin antibody in diagnosis of SS in English and Chinese published between January 1997 and December 2007 were retrieved from the Cocharane Library, Medline, Embase, and China National Knowledge Infrastructure (CNKI) databases, etc. Two reviewers independently assessed the methodological quality of each study with the tool QUADAS ( quality assessment of diagnostic accuracy studies). Statistical analysis was performed by employing MATLAB, Review Manager 4.2 and Meta-Discl. 4. A reefs-analysis of the reported sensitivity and specificity of each study and Summary Receiver Operating Characteristic (SROC) curve was performed. Results Eighteen literatures were included at last. After testing the heterogeneity of the included articles, proper effect model was selected to calculate the pooled weighted sensitivity and specificity with 95% confidence interval: for anti-α-fodrin antibody IgG, the sensitivity was 0.40 [95% CI(0.37-0.43)] and the specificity was 0.82 [95% CI(0.79-0.84)], the area under the curve (AUC) of SROC was 0.8029 (SE=0.0580). Eight studies tested anti-α-fodrin antibody lgA, the pooled weighted sensitivity and specificity with 95% confidence interval were 0.34 [95% CI(0.30-0.38) ] and 0. 83 [95% CI(0.79-0.86) ] respectively, the AUC of SROC was 0.6374 (SE=0.1841), the synthesis data all showed heterogeneity. The subgroups were analyzed to identify the sources of heterogeneity according to age, race, assay method, agent source, diagnostic criteria, and country. There was homogenicity among the 4 studies from China, and the 6 studiesfrom Japan,the AUC of SROC were 0.7343 (SE=0.0448) and 0. 9273 (SE=0.0394), respectively. Conclusion Diagnostic criteria, agent source, assay method, age, race, and country are the important sources of heterogeneity. Anti-a-fedrin antibodies IgG and IgA have relatively low pooled sensitivity and relatively high pooled specificity. Negative anti-a-fodrin antibody has not important value in excluding SS, but positive anti-α-fodrin antibody may be a useful parameter in clinical diagnosis of SS.