摘要
目的系统评价血清IgG4对IgG4相关性疾病(IgG4-RD)的诊断价值。方法计算机检索PubMed、EMBASE、万方数据库、维普数据库和中国知网数据库,收集自2011年1月1日至2020年1月1日所有以探讨血清IgG4对IgG4相关性疾病诊断价值为目的的英文文献,制定严格的纳入及排除标准进行文献筛选及数据提取,采用质量评价工具(QUADAS-2)进行文献质量评估,采用Meta-Disc 1.4软件及STATA15.0软件中“midas”命令进行异质性分析及综合定量合成,计算合并的敏感度、特异度、诊断优势比、阳性似然比及阴性似然比,绘制相关森林图并拟合受试者工作特征曲线(SROC)。将纳入文献按地区、疾病类型以及样本量大小进行亚组分析。结果共有17篇文献,17095名研究对象纳入本次Meta分析,IgG4的临界值为1.3~1.44 g/L,各研究合并的灵敏度0.88(95%CI:0.81-0.93),特异度为0.89(95%CI:0.83-0.93),阳性似然比为8.3(95%CI:5.1-13.7),阴性似然比为0.13(95%CI:0.08-0.22),诊断优势比为62(95%CI:25-153)。11篇文献报道了血清IgG4>2×ULN(2.7-2.8 g/L)时的诊断价值,各研究合并的灵敏度0.59(95%CI:0.47-0.7),特异度为0.96(95%CI:0.94-0.97),阳性似然比为14.3(95%CI:9.1-22.7),阴性似然比为0.42(95%CI:0.32-0.57),诊断优势比为34(95%CI:17-69)。亚组分析显示地域、是否仅纳入自身免疫性胰腺炎(AIP)患者以及IgG4-RD患者样本量大小均可能为异质性来源。Deeks漏斗图显示不存在发表偏倚,敏感性分析结果稳定可靠。结论血清IgG4在IgG4-RD的诊断中具有较高的参考价值,提高临界值至2×ULN并没有明显的诊断优势,这一结果仍需更多前瞻性高质量诊断试验进行验证。
Objective To systematically evaluate the diagnostic value of serum IgG4 for IgG4-related diseases(IgG4-RD).Methods All related English studies to explore diagnostic value of serum IgG4 in IgG4-related diseases published in PubMed,EMBASE,Wangfang,Weipu and CNKI from January 1st,2011 to January 1st,2020 were searched by computer.Strict inclusion and exclusion criteria for literature screening and data extraction were established,the quality assessment was made by the quality evaluation tool(QUADAS-2),and meta-disc 1.4 software and the“Midas”command in STATA15.0 software were used for heterogeneity analysis and comprehensive quantitative synthesis.The pooled sensitivity,specificity,diagnostic advantage ratio,positive likelihood ratio and negative likelihood ratio were calculated respectively,and the relevant forest map was drawn,and the summary receiver operating curve(SROC)was fitted.The included literature were subgroup analyzed by region,disease type and sample size.Results A total of 17 articles and 17095 patients were included in this meta-analysis.The cut-off value of IgG4 ranged from 1.3 to 1.44 g/L,the pooled sensitivity was 0.88(95%CI:0.81-0.93),the pooled specificity was 0.89(95%CI:0.83-0.93),the pooled positive likelihood ratio was 8.3(95%CI:5.1-13.7),the pooled negative likelihood ratio was 0.13(95%CI:0.08-0.22)and the diagnostic advantage ratio was 62(95%CI:25-153),respectively.The diagnostic value of serum IgG4>2×ULN(2.7-2.8 g/L)was reported in 11 studies,and the pooled sensitivity was 0.59(95%CI:0.47-0.7),the pooled specificity was 0.96(95%CI:0.94-0.97),the pooled positive likelihood ratio was 14.3(95%CI:9.1-22.7),the pooled negative likelihood ratio was 0.42(95%CI:0.32-0.57),and the pooled diagnostic advantage ratio was 34(95%CI:17-69).Subgroup analysis showed that geography,whether only AIP patients were included,and sample size of IgG4-RD patients were all possible sources of heterogeneity.Deeks funnel plot showed no publication bias,and the sensitivity analysis revealed that the analysis result were stable and reliable.Conclusion Serum IgG4 has a high reference value in the diagnosis of IgG4-RD,and there is no significant diagnostic advantage in increasing the cut-off value to 2×ULN.This result still needs to be verified by more prospective and high-quality diagnostic tests.
作者
丁航
刘源
张连峰
周琳
Ding Hang;Liu Yuan;Zhang Lianfeng;Zhou Lin(Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China)
出处
《临床荟萃》
CAS
2021年第7期587-594,共8页
Clinical Focus
