摘要
目的通过Meta分析确定检测脑脊液(CSF)中腺苷脱氨酶(ADA)的含量是否有助于结核性脑膜炎的早期诊断。方法检索Medline,Embase,BIOSIS和Cochrane等数据库,检索时间为1995年1月至2009年12月,收集关于测定CSF中ADA以诊断结核性脑膜炎的相关英文文献,并用QUADAS标准进行质量评价,采用Metadisc1.4和SPSS13.0软件,用随机效应模型汇总各研究中ADA诊断结核性脑膜炎的敏感度、特异度以及其他指标,绘制汇总受试者工作特征曲线并探讨其诊断特性。结果最终有9项独立研究纳入本次Meta分析,ADA诊断结核性脑膜炎的总体敏感度0.77(95%CI 0.72～0.82);特异度0.91(95%CI 0.90～0.93);阳性似然比7.93(95%CI 5.85～10.76),阴性似然比0.28(95%CI 0.19～0.41),合并受试者工作特征曲线下面积为0.9129,但在结核性脑膜炎与化脓性脑膜炎的鉴别诊断中特异度降为0.75(95%CI 0.67～0.82)。结论 ADA诊断结核性脑膜炎的敏感度、特异度均较高,检测CSF中的ADA有助于结核性脑膜炎的诊断,但在与化脓性脑膜炎相鉴别时诊断效力下降,需参考其他检测指标。
Objective To investigate the effect of Adenosine deaminase （ADA） from Cerebrospinal fluid （CSF） in early diagnosis of tuberculous meningitis via a meta-analysis. Methods Between January 1995 and December 2009, Medline, EMbase, BIOSIS and Cochrane databases were searched for relevant English articles on detection of ADA from CSF in diagnosis of tuberculous meningitis. Quality evaluation of these studies was performed using QUADAS standards. The random effect model of Metadisc 1.4 and SPSS 13.0 softwares was used for pooled analysis of the sensitivity, specificity and other indexes of ADA in diagnosis of tuberculous meningitis in all studies. The receiver operating characteristic curves were then generated and studied for its use in diagnosis. Results Nine studies were finally included in this meta-analysis. The overall sensitivity of ADA in diagnosis of tuberculous meningitis was 0. 77 （ 95 % CI 0. 72 - 0. 82 ） , specificity 0. 91 （ 95 % CI 0. 90 - 0. 93 ）, positive likelihood ratio 7.93 （5.85 - 10. 76） ,negative likelihood ratio 0. 28 （0. 19 - 0.41 ） and area under curve （AUC） of SROC 0. 9129. However,the specificity of differential diagnosis between tuberculous and purulent meningitis was decreased to 0. 75 （95 % CI 0. 67 -0. 82）. Conclusion Both sensitivity and specificity of ADA were favorably high in diagnosis of tuberculous meningitis. The detection of ADA in CSF might contribute to diagnosis of tuberculous meningitis ; however, this could lead to lowered efficiency in differential diagnosis against purulent meningitis, hence a need for references to other laboratory indexes.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2011年第5期358-361,共4页
Chinese Journal of Practical Internal Medicine
关键词
META分析
结核性脑膜炎
腺苷脱氨酶
脑脊液
Meta-analysis
tuberculous meningitis
adenosine deaminase
cerebrospinal fluid
