摘要
目的系统评价糖化血红蛋白(HbA1c)在中国人群妊娠期糖尿病(GDM)诊断中的价值。方法计算机检索EMbase、PubMed、The Cochrane Library、CNKI、WanFang Data、VIP数据库,搜集糖化血红蛋白与金标准(口服75g葡萄糖耐量试验,OGTT)比较诊断中国人群GDM的研究,检索时限均为建库至2016年10月。由2名研究者独立筛选文献、提取资料并采用QUADAS-2工具评价纳入研究的偏倚风险后,使用RevMan5.3软件和Meta Disc 1.4软件进行Meta分析。结果共纳入33个研究,包括16 622例受试者。Meta分析结果显示,糖化血红蛋白诊断GDM的Sen_(合并)、Spe_(合并)、+LR_(合并)、–LR_(合并)和DOR_(合并)分别为:0.75[95%CI(0.74,0.77)]、0.91[95%CI(0.90,0.91)]、8.21[95%CI(5.41,12.46)]、0.18[95%CI(0.11,0.28)]、45.10[95%CI(29.70,68.48)],汇总受试者工作特征曲线(SROC)下面积(AUC)为0.933 5。以不同Hb A1c检测方法进行亚组分析,结果显示不同Hb A1c检测方法诊断GDM的敏感度和特异度变化不大。结论 HbA1c诊断GDM具有较高的敏感性和特异性。受纳入研究的数量和质量的限制,上述结论尚需开展更多研究予以证实。
Objective To systematically review the diagnosis value of glycosylated hemoglobin （HbAlc） in diagnosis of gestational diabetes mellitus （GDM）. Methods The diagnostic studies concerning glycosylated hemoglobin in gestational diabetes were electronically searched in EMbase, PubMed, The Cochrane Library, CNKI, WanFang Data and VIP from inception to October, 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies by QUADAS-2 standard. Meta-analysis was performed by RevMan 5.3 and Meta-Disc 1.4 software. Results A total of 33 studies involving 16 622 persons were included. The results of meta-analysis showed that the pooled sensitivity, specificity, positive predictive value, negative predictive value, the pooled DOR of HbAlc were 0.75 （95%CI 0.74 to 0.77）, 0.91 （95%CI 0.90 to 0.91）, 8.21 （95%CI 5.41 to 12.46）, 0.18 （95%CI 0.11 to 0.28）, 45.10 （95%CI 29.70 to 68.48）, respectively. The AUC of SROC was 0.933 5. Subgroup analysis by different HbAlc measurements indicated that little variations between different measurements in sensitivity and specificity. Conclusion HbAlc in GDM diagnosis has high sensitivity and specificity. Due to the limited quality and quantity of included studies, the above results should be validated by more studies.
作者
娜仁其木格
李冬梅
梁宏伟
米林香
Narenqimuge LI Dongmei LIANG Hongwei MI Linxiang(Department of Endocrinology Inner Mongolia Autonomous Region People＇s Hospital, Hohhot, 010010, P.R. China)
出处
《中国循证医学杂志》
CSCD
2017年第7期774-782,共9页
Chinese Journal of Evidence-based Medicine
基金
内蒙古自治区自然科学基金项目(编号:2015MS08145)
