摘要
目的评价血浆同型半胱氨酸（homocysteine，Hcy）在糖尿病肾脏疾病（diabetic kidney disease，DKD）中的诊断价值。方法计算机检索The Cochran Library、PubMed、中国知网（CNKI）、万方数据库及中国生物医学文献数据库（CBM），查找自建库以来至2015年9月20日所有关于血浆Hey诊断DKD的文献。按照纳入和排除标准对文献进行严格筛选，采用诊断性试验准确性质量工具（quality assessment of diagnostic accuracy studies，QUADAS）评价纳入文献的质量，应用Meta-discl．4软件进行Meta分析，计算血浆Hcy对DKD诊断的合并敏感度、特异度、阳性似然比、阴性似然比及诊断比值比（diagnostic odds ratio，DOR），绘制综合受试者工作特征曲线图（summary receiver operating characteristics，SROC），并计算曲线图下面积（area under curve，AUC）及Q^＊值。采用Stata11．0软件绘制漏斗图评价发表偏倚。结果共纳入文献15篇，研究对象共2964例。Meta分析结果显示：合并的敏感度为0．78（95％CI：0．75～0．80）；特异度为0．85（95％CI：0．83～0．87）；阳性似然比为5．87（95％CI：3．81～9．04）；阴性似然比为0．26（95％CI：0．17～0．39）；DOR为27．02（95％CI：12．52~58．30）。综合的受试者工作特征曲线下面积为0．9154；Q‘=0．8481。Deeks漏斗图显示无明显发表偏倚[斜率系数的P=0．159，t=-1．50（95％CI：-99．37～18．08）]。结论目前研究证据表明，血浆Hcy对DKD具有较高的诊断价值。由于敏感度中等水平，存在一定的漏诊率，还需联合检测尿微量白蛋白等指标，减少漏诊的发生。
Objective To evaluate the diagnostic value of plasma homocysteine for diabetic kid- ney disease（DKD）. Methods The databases of the Cochran Library, PubMed, CNKI, WanFang Da- tabase, and CBM were retrieved by computer for collecting the relative literature about diagnostic val- ue of plasma homocysteine for DKD from inception to September 20th, 2015. Two reviewers inde- pendently and strictly screened literature according to the inclusion and exclusion criteria. The tools of quality assessment of diagnostic accuracy studies （QUADAS） were used to assess the quality of in- cluded studies. Meta-analysis was then performed using Meta-Disc 1.4 software. The pooled sensitivi- ty, specificity, .positive likehihood ratio, negative likelihood ratio and diagnostic odds ratio （DOR） were calculated, the summary receiver operating characteristic curve （SROC） was drawn, and the area under the curve （AUC） and Q^＊ value were calculated. The publication bias was evaluated using Stata 11.0 software. Results A total of 15 studies involving 2964 cases were inculded. The results of meta- analysis showed that the pooled sensitivity was 0. 78 （95% CI：0. 75 - 0. 80）; specificity was 0. 85 （95% CI： 0. 83 - 0. 87） ; positive likehihood ratio was 5.87 （95% CI： 3. 81 - 9. 04） ; negative likeli- hood ratio was 0. 26 （95% CI： 0. 17- 0. 39） ; DOR was 27. 02 （95% CI： 12. 52 - 58. 30） ; the AUC of SROC was 0. 9154; Q^＊ value was 0. 8481. Deeics funnel plot showed that there was no significant publication bias. Conclusions The present research evidence showed that the test of plasma homocys- teine has the higher value of diagnosing DKD. Because of an intermediate-level sensitivity, it still needs the test of combination with urine mircoalbumin to reduce missing diagnostic rate.
出处
《临床肾脏病杂志》
2016年第7期412-417,共6页
Journal Of Clinical Nephrology
