摘要
目的系统评价当前研究血清透明质酸诊断肝纤维化文献的质量,分析偏倚和变异产生的来源,并了解血清透明质酸对诊断慢性病毒性肝炎所致早期肝硬化、肝纤维化的准确性。方法采用计算机和手工检索全面收集当前研究血清透明质酸对慢性病毒性肝炎所致肝纤维化的诊断性试验文献,并根据QUADAS(quality assessment of diagnostic accuracy studies)质量评价标准评价符合纳入标准的文献的质量,用Meta-disc软件对敏感性、特异性、阳性似然比(+LR)、阴性似然比(-LR)、诊断性试验比值比等进行合并分析和异质性检验,对无异质性的文献用DPS2005软件绘制SROC曲线。结果共纳入符合纳入标准的文献24篇,其中中、英文文献各占一半。在合并分析中,放射免疫法诊断肝硬化文献,以及区分有无肝纤维化的文献合并+LR分别为7．029、3 608；合并-LR分别为0．198、0．319。酶联免疫法中,诊断肝硬化的文献、鉴别轻、重度肝纤维化的文献,区分有无肝纤维化的文献的合并+LR分别为6 093、9．806和4．308；合并-LR分别为0．354、0．347和0．563。结论本系统评价所纳入24篇文献的偏倚主要来自参考标准判读时未实施盲法,存在变异的可能性较大,报告质量较差。放射免疫法和酶联免疫法血清透明质酸对肝硬化具有较好的诊断价值,对有无肝纤维化的判别价值也可认可,但该两种检测方法在鉴别轻、重度肝纤维化的诊断价值尚需进一步研究。
Objective To evaluate the quality of the current studies involving the value of serum hyaluronic acid in the diagnosis of liver fibrosis, analyze the sources of bias and variation, and estimate the accuracy of serum hyaluronic acid in diagnosing early liver cirrhosis and liver fibrosis in patients with chronic viral hepatitis. Methods We searched MEDLINE （1966 to June 2006）, EMbase （1974 to June 2006）, CBMdisc （1978 to April 2005）, CNKI （2005 to June 2006） and VIP （2005 to June 2006） for studies involving the diagnostic value of serum hyaluronic acid for liver fibrosis in patients with chronic viral hepatitis. We also handsearched the references of included studies. QUADAS items were used for quality assessment. Meta- disc software was used to analyze sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic test odds ratio for the pooled analysis and heterogeneity test. Meta-DiSc ver 1.4 software was used to draw SROC curves for those without heterogeneity. Results Totally 24 studies were included, 12 Chinese studies and 12 English studies. Results of the pooled analysis showed that, as for radioimmunoassay （RLA）, the pooled LR＋ of the studies involving the diagnosis of liver cirrhosis and the differentiation of absen/present liver fibrosis were 7.029 and 3.608; and the pooled LR- were 0.198 and 0.319, respectively. As for enzyme-linked immunosorbent assay （ELISA）, the pooled LR＋ of the studies involving the diagnosis of liver cirrhosis, the differentiation of mild/severe and absent/present liver fibrosis were 6.093, 9.806 and 4.308; and the pooled LR- were 0.354, 0.347 and 0.563, respectively. Conclusion The bias identified from the 24 studies may be mainly resulted from reference standard review bias. There exists the possibility of greater variation and poorer reporting quality. By both RIA and ELISA methods, serum hyaluronic acid has a sound value in diagnosing live cirrhosis. Its value in differentiating absent/present liver fibrosis is also acceptable. However, its value in differentiating mild/severe liver fibrosis needs to be further studied.
出处
《中国循证医学杂志》
CSCD
2007年第2期112-120,共9页
Chinese Journal of Evidence-based Medicine
关键词
血清透明质酸
慢性病毒性肝炎
肝纤维化
诊断性试验
质量评价
系统评价
Serum hyaluronic acid
Chronic viral hepatitis
Liver fibrosis
Diagnostic test
Quality assessment
Systematic review
