血清YKL-40对肝纤维化分期诊断价值的Meta分析

目的探讨血清YKL-40蛋白对肝纤维化分期的诊断价值,为慢性肝病肝纤维化的无创诊断提供参考。方法系统检索数据库包括Pub Med、EMBASE、the Cochrane Library、Web of Science、CNKI等针对YKL-40诊断肝纤维化或者肝硬化临床价值的研究,使用质量评估方法(QUADAS-2)评价文献,采用Stata12.0软件对纳入研究进行综合定量评价,检验识别偏倚情况,分析异质性来源并且绘制森林图和汇总受试者工作曲线(SROC)。结果最终纳入9篇文献,共1592例患者,其中6篇文献对显著性肝纤维化(≥F2)进行研究;7篇对进展性肝纤维化(≥F3)进行研究。YKL-40诊断显著性肝纤维化(≥F2)的合并敏感度和特异度分别是0.78[95%可信区间(95%CI):0.69~0.85]、0.53(95%CI:0.33~0.72),阳性似然比为1.7(95%CI:1.0~2.7),阴性似然比为0.41(95%CI:0.21~0.76),优势比值比为4(95%CI:1~13)、SROC曲线下面积(AUC)是0.76(95%CI:0.72~0.80)。YKL-40诊断进展性肝纤维化(≥F3)的合并敏感度和特异度分别是0.83(95%CI:0.76~0.89)、0.72(95%CI:0.62~0.80),阳性似然比为3.0(95%CI:2.0~4.4),阴性似然比为0.23(95%CI:0.14~0.37),诊断比值比为13(95%CI:5~30)、AUC为0.85(95%CI:0.82~0.88)。结论鉴于血清YKL-40在显著性肝纤维化和进展性肝纤维化方面的诊断价值有限,其成为新的、有效的诊断肝纤维化分期的血清标志物有待进一步验证。     

微小RNA对中国急性心肌梗死患者早期诊断价值的Meta分析

目的:评价微小RNA(miRNAs)对中国急性心肌梗死(AMI)患者的早期诊断价值。方法:采用Cochrane系统评价的基本方法,全面检索Pubmed、Medline、Web of science、中国期刊全网全文数据库(CNKI)、万方数据库、中国生物医学文献数据库,无语言限制,搜集评价miRNAs对中国AMI患者诊断价值的文献,以灵敏度(Sen)、特异度(Spe)、诊断优势比(DOR)及受试者工作特征曲线下面积(SROC)作为诊断效能的评价指标,采用MetaDisc1.4软件进行系统评价和Meta分析。结果:共纳入24篇文献,其中英文15篇,中文9篇。Meta分析结果显示:总miRNAs的合并Sen、Spe和SROC面积分别为0.73(95%CI:0.72~0.75)、0.82(95%CI:0.81~0.84)和0.8783;miRNA-499的合并Sen、Spe和SROC面积为0.78(95%CI:0.75~0.81)、0.76(95%CI:0.72~0.79)和0.8781;miRNA-1的合并Sen、Spe和SROC面积为0.73(95%CI:0.69~0.78)、0.84(95%CI:0.80~0.87)和0.8374;miRNA-208的合并Sen、Spe和SROC面积为0.73(95%CI:0.68~0.77)、0.85(95%CI:0.80~0.88)和0.8658;miRNA-133的合并Sen、Spe和SROC面积为0.75(95%CI:0.70~0.80)、0.88(95%CI:0.84~0.92)和0.9391。结论:miRNA是一种新型的心脏损伤标志物,尤其miRNA-133对早期AMI具有较强的诊断价值,但仍需要更大样本高质量的临床试验加以验证。     

血清p16甲基化对肺癌诊断价值的荟萃分析

目的采用Meta分析的方法评价血清p16甲基化在肺癌诊断中的价值。方法检索PubMed、ISI Web of Knowledge、Springerlink、Elsevier、OVID等数据库,检索时间截止为2010年10月,收集研究血清P16甲基化对肺癌诊断价值的相关文献;按纳入与排除标准筛选文献,并对纳入文献进行质量评价;采用MetaDisc1.4软件对数据进行异质性分析,计算汇总敏感度、特异度、汇总似然比,做汇总受试者工作特征曲线(SROC曲线),综合评价血清P16甲基化在肺癌诊断中的价值。结果共纳入10篇文献,分析病例组肺癌患者602例,对照组530例。对入选10篇文献进行异质性检验,提示所纳入文献具有齐性,应用固定效应模型进行Meta分析。分析结果:汇总灵敏度为0.37(95%CI0.33~0.41),汇总特异度为0.96(95%CI0.94~0.98),汇总阳性似然比为11.51(95%CI6.84~19.36),汇总阴性似然比为0.66(95%CI0.62~0.72),SROC曲线下面积为0.8511。结论血清p16甲基化在肺癌的诊断中有很高的特异度和一定的灵敏度,在肺癌诊断中有一定的参考价值。     

TGFβ1对原发性肝癌诊断价值的Meta分析

目的采用Meta分析方法系统评价TFGβ1在原发性肝癌(以下简称肝癌)诊断中的价值。方法计算机检索Pub Med、EMBASE、Cochrane Library、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方数据库及维普数据库中公开发表的TGFβ1诊断原发性肝癌的文献,检索时间为数据库建库至2016年6月30日。筛选出的文献采用OQAQ量表进行评价质量。通过Stata 13.0软件进行效应量诊断比值比、阳性似然比、阴性似然比等指标合并,并绘制综合受试者工作特征曲线(SROC曲线),进行发表偏倚检验。可信度以95%可信区间(95%CI)表示。异质性检验采用Q检验和I2检验,同时进行亚组分析。结果共纳入16篇文献,合计肝癌组1124例,对照组1443例。敏感度及95%CI为0.68(0.52~0.80),特异度及95%CI为0.85(0.74~0.92),诊断比值比及95%CI为11.75(6.18~22.36);阳性似然比及95%CI为4.6(2.7~7.9),阴性似然比及95%CI为0.38(0.26~0.56),SROC曲线下面积及95%CI为0.84(0.80~0.87)。亚组分析所得结果显示,ELISA检测方法的阳性似然比、诊断比值比和SROC曲线下面积均高于免疫组化检测,阴性似然比小于免疫组化检测。纳入的文献存在异质性,主要来源为研究对象的肝病背景不同,非原发性肝癌组的构成不统一(包含良性对照组和正常对照),以及实验设计差异等导致。描绘Deeks漏斗图,提示无明显发表偏倚。结论 TGFβ1在肝癌的诊断中具有较高的灵敏度及特异度,有可能成为肝癌的一种辅助诊断指标。     

果糖胺检测对糖尿病诊断价值的Meta分析

目的评价果糖胺检测在糖尿病诊断中的临床价值。方法检索PubMed、EMbase、Ovid、CNKI、万方数据库,系统评价果糖胺检测对糖尿病的诊断价值。采用RevMan 5.2和Meta-Disc 1.4软件行综合定量评价,Stata 11.0软件评价发表偏倚。结果最终纳入19篇文献。Meta分析结果显示,合并敏感性0.76(95%CI:0.74~0.78),合并特异性0.89(95%CI:0.88~0.90),阳性似然比8.47(95%CI:5.47~13.12),阴性似然比0.24(95%CI:0.19~0.30),合并诊断比值比41.05(95%CI:23.37~72.10),异质性的差异有统计学意义(P0.01);受试者工作特征(ROC)曲线下面积(AUC)为0.9205,Q*指数为0.8540;Begg(P=0.484)和Egger检验(P=0.155)均提示不存在发表偏倚。结论果糖胺检测对糖尿病诊断有一定参考价值。     

半乳糖凝集素3对心力衰竭诊断价值的Meta分析

目的采用Meta分析评估半乳糖凝集素3对心力衰竭(心衰)的诊断价值。方法检索PubMed、EMbase、万方数据库和中国知网自数据库建库开始至2018年11月30日之前收录的关于半乳糖凝集素3对心力衰竭(心衰)诊断效能的中英文文献并提取数据,使用诊断准确性研究的质量评价工具-2(QUADAS-2)对纳入文献进行质量评估,采用MetaDiSc1.4软件全面分析半乳糖凝集素3诊断心力衰竭的价值。结果共纳入文献14篇,纳入研究存在非阈值效应引起的异质性,采用随机效应模型合并结果,合并灵敏度为0.78(95%CI:0.76~0.80);合并特异度为0.65(95%CI:0.63~0.68);合并阳性似然比为2.85(95%CI:2.07~3.92);合并阴性似然比0.28(95%CI:0.21~0.39);合并诊断比值比(DOR)为12.48(95%CI:6.48~24.06);ROC曲线下面积(AUC)为0.8531。结论半乳糖凝集素3对心衰有中等偏高程度的诊断价值,但仍需要设计合理的大样本研究来证明。     

microRNA-499对急性心肌梗死诊断价值的Meta分析

目的:系统评价microRNA-499(miRNA-499)在急性心肌梗死(AMI)患者诊断中的临床价值。方法:计算机检索Cochrane Library Medline、Embase、Pubmed、万方数据库、维普中国科技期刊数据库、中国生物医学文献数据库、中国知网数据库有关miRNA-499诊断AMI的文献。采用MetaDisc1.4软件进行系统评价。评价指标为总体灵敏度、特异度、阳性似然比、阴性似然比、诊断优势比以及受试者工作特征曲线(SROC)下面积。结果:共纳入15篇文献,合计AMI患者1 943例,健康者1 867例。Meta分析结果显示,miRNA-499诊断AMI的总体灵敏度为0.83(95%CI:0.82~0.85);特异度为0.79(95%CI:0.77~0.80);阳性似然比为5.73(95%CI:3.74~8.78);阴性似然比为0.21(95%CI:0.16~0.29);诊断优势比为26.29(95%CI:15.24~45.34)。SROC曲线下面积为0.881 8。结论:miRNA-499对AMI诊断具有较高的灵敏度和特异度,有较强的诊断价值。     

微小核糖核酸作为急性脑梗死诊断标志物的Meta分析

目的:通过Meta分析方法,分析miRNA作为急性脑梗死诊断标志物的价值。方法:检索Medline、PubMed、Embase、Cochrane Library Database、万方数据库、中国学术期刊网全文数据库(CNKI)和维普数据库(VIP)相关文献,检索时间从建库至2018年12月。纳入的研究通过诊断准确性研究质量评价工具(QUADAS)进行质量评价,并采用Stata 14和Meta-Disc 1.4进行Meta分析,采用随机效应模型合并分析灵敏度(SEN)、特异度(SPE)、阳性似然比(PLR)、阴性似然比(NLR)和诊断比势比(DOR)。通过受试者工作特征(ROC)曲线和曲线下面积(AUC)估计整体检验效能。结果:最终共纳入19个研究,包含急性脑梗死患者1543例,对照组1037例。整体miRNA诊断急性脑梗死的SEN、SPE分别为0.82(95%CI:0.80~0.83)、0.81(95%CI:0.79~0.83),PLR为5.19(95%CI:3.61~7.47),NLR是0.24(95%CI:0.20~0.30),DOR为24.01(95%CI:14.92~38.64)。SROC曲线的AUC为0.89。结论:在诊断急性期脑梗死方面,miRNA具有较高的灵敏度,是较好的诊断标志物。     

超声内镜引导下细针穿刺活检对胰腺实性占位定性诊断价值的Meta分析

目的:系统评价超声内镜引导下细针穿刺活检(EUS-FNA)在胰腺实性占位定性诊断中的价值.方法:计算机检索MEDLINE、Cochrane Library、中国生物医学文献数据库、万方数据库、中国学术期刊全文等数据库,检索时间均为建库至2011-10.全面查找有关EUS-FNA诊断胰腺实性占位的文献,按照诊断试验的纳入标准筛选文献,提取纳入文献的特征信息(研究背景、设计信息和诊断参数信息),根据QUADAS质量评价标准纳入文献的质量.采用Meta-Disc1.4软件进行Meta分析,检验异质性,并根据异质性结果选择相应的效应模型.对纳入文献予以加权定量合并,计算汇总敏感度、特异度、阳性似然比、阴性似然比和诊断优势比及其95%CI,绘制汇总受试者工作特征(SROC)曲线,并计算曲线下面积(AUC).结果:共检索出相关文献280篇,按照文献纳入标准,最终纳入18篇文献(均为英文文献).EUS-FNA对胰腺实性占位定性诊断价值分别为:汇总敏感度为0.90[95%CI(0.89-0.92)],汇总特异度为0.95[95%CI(0.93-0.97)],汇总阳性似然比为13.56[95%CI(8.31-22.15)],汇总阴性似然比为0.12[95%CI(0.10-0.15)],汇总诊断优势比为143.62[95%CI(93.98-219.46)],SROC曲线下面积AUC为0.9711,Q*=0.9215.另外,本研究还对有无病理医生在场指导进行了亚组分析,发现有病理医生在场的AUC为0.9757,Q*=0.9295.且汇总诊断优势比173.37[95%CI(98.09-306.44)],明显较无病理医生在场的113.64[95%CI(60.22-214.46)]高.结论:经SROC曲线证实,EUS-FNA活检在胰腺实性占位定性诊断中具有较高的灵敏度和特异度,尤其是有病理医生在场指导的情况下,可作为临床上胰腺实性占位定性诊断的重要检查手段.     

国人平板运动试验诊断冠心病价值的Meta分析

目的 评价平板运动试验对冠心病的诊断价值. 方法检索1994至2007年国内公开发表的有关平板运动试验对冠心病诊断精确性的临床试验文献,按Cochrane协作网推荐的方法进行Meta分析.结果 共纳入13篇文献,平板运动试验对冠心病诊断的敏感性为0.59～0.81,特异性为0.55～0.88;合并敏感性和合并特异性分别为0.75(95%Cl 0.72～0.79)、0.72(95%Cl 0.69～0.76),合并阳性似然比和合并阴性似然比分别为2.59(95%Cl 2.22～3.03)、0.35(95%Cl 0.30-0.40).SROC曲线下面积为0.8044±0.0148.结论平板运动试验对冠心病具有中等的诊断价值.     

Diagnostic precision of endoanal MRI in the detection of anal sphincter pathology—a meta-analysis

Objective This study aims to evaluate the diagnostic precision of endoanal magnetic resonance imaging in identifying anal sphincter injury and/or atrophy when compared with either endoanal ultrasound or surgical diagnosis. Materials and methods Quantitative meta-analysis was performed on nine studies, comparing endoanal MRI with endoanal ultrasound or surgical diagnosis in 157 patients. Sensitivity, specificity, and diagnostic odds ratio were calculated for each study. Summary receiver operating characteristic curves (SROC) and subgroup analysis were undertaken. Results The overall sensitivity and specificity of endoanal MRI for external sphincter injury was 0.78 (95%CI: 0.66–0.84) and 0.66 (95%CI: 0.51–0.79), respectively. For internal sphincter injury detection, this was 0.63 (95%CI: 0.50–0.74) and 0.71 (95%CI: 0.60–0.81), respectively. For detection of atrophy, this was 0.86 (95%CI: 0.71–0.95) and 0.82 (95%CI: 0.65–0.93), respectively. The area under the SROC curve and diagnostic odds ratio were 0.84 (SE = 0.07) and 6.14 (95%CI: 2.17–17.4) for external sphincter injury, 0.79 (SE = 0.07) and 4.60 (95%CI: 1.75–12.15) for internal sphincter injury, and 0.92 (SE = 0.08) and 21.49 (95%CI: 2.87–160.64) for sphincter atrophy. Conclusion Endoanal MRI was sensitive and specific for the detection of external sphincter injury and especially sphincter atrophy. It may be useful as an alternative to endoanal ultrasound in patients presenting with fecal incontinence, although further clinical studies are needed to identify its best application in clinical practice.     

CT血管成像与MR血管成像对颅内动脉瘤诊断价值的Meta分析

目的通过Meta分析,比较CT血管成像（CTA）与MR血管成像（MRA）对颅内动脉瘤的诊断价值。方法检索维普中文科技期刊数据库、中国生物医学文献数据库、中国期刊全文数据库、数字化期刊数据库、PubMed、EMBASE、Web of Science、Cochrane Library,按照纳入标准筛选关于CTA和MRA对颅内动脉瘤诊断的研究,检索时间均由建库至2012年4月。采用Metadisc 1.4软件对数据进行分析,计算诊断的敏感度、特异度、比值比（OR）及95%CI,异质性采用I2检验分析,绘制出汇总受试者工作特征曲线（SROC）,并计算曲线下面积。结果共纳入6篇符合标准的文章（均为前瞻性研究）,合计370例患者。Meta分析结果示,CTA对颅内动脉瘤诊断的敏感度为0.91（95%CI：0.87～0.94）,特异度为0.92（95%CI：0.86～0.96）,OR为78.29（95%CI：28.27～216.77）,SROC曲线下面积为0.9593。MRA诊断的敏感度为0.85（95%CI：0.80～0.89）,特异度为0.92（95%CI：0.86～0.96）,OR为41.94（95%CI：18.50～95.09）,SROC曲线下面积为0.9304。结论 CTA对于颅内动脉瘤的诊断价值高于MRA。但仍需大样本的研究进一步加以证实。     

Magnetic resonance cholangiography in assessing biliary anatomy in living donors: A meta-analysis

AIM:To establish the role of magnetic resonance cholangiography(MRC)in diagnosis of biliary anatomy in living-donor liver transplantation(LDLT)donors.METHODS:A systematic review was performed by searching electronic bibliographic databases prior to March 2013.Studies with diagnostic results and fulfilled inclusion criteria were included.The methodological quality of the studies was assessed.Sensitivity,specificity and other measures of the accuracy of MRC for diagnosis of biliary anatomy in LDLT donors were summarized using a random-effects model or a fixed-effects model.Summary receiver operating characteristic(SROC)curves were used to summarize overall test performance.Publication bias was assessed using Deek’s funnel plot asymmetry test.Sensitivity analysis was adopted to explore the potential sources of heterogeneity.RESULTS:Twelve studies involving 869 subjects were eligible to the analysis.The scores of Quality Assessment of Diagnostic Accuracy Studies for the included studies ranged from 11 to 14.The summary estimates of sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic OR of MRC in diagnosis of biliary anatomy in LDLT donor were 0.88(95%CI:0.84-0.92),0.95(95%CI:0.93-0.97),15.33(95%CI:10.70-21.95),0.15(95%CI:0.11-0.20)and 130.77(95%CI:75.91-225.27),respectively.No significant heterogeneity was detected in all the above four measures.Area under SROC curve was 0.971.Little publication bias was noted across the studies(P=0.557).Sensitivity analysis excluding a study with possible heterogeneity got a similar overall result,which suggested the little influence of this study on the overall results.CONCLUSION:Our results suggest that MRC is a high specificity but moderate sensitivity technique in diagnosis of biliary anatomy in LDLT donors.     

Dabigatran,rivaroxaban, and apixaban are superior to warfarin in Asian patients with non-valvular atrial fibrillation: An updated meta-analysis

BACKGROUNDMost of the randomized clinical trials that led to the wide use of non-vitamin K antagonist oral anticoagulants for stroke prevention in patients with atrial fibrillation (AF) originated from western countries. AIMTo systematically review and quantitatively synthesize the real-world data regarding the efficacy and safety of dabigatran, rivaroxaban, and apixaban compared to warfarin for stroke prevention in Asian patients with non-valvular AF.METHODSMedline, Cochrane, and ClinicalTrial.gov databases were reviewed. A random-effect model meta-analysis was used and I-square was utilized to assess the heterogeneity. The primary outcome was ischemic stroke. The secondary outcomes were all-cause mortality, major bleeding, intracranial hemorrhage, and gastrointestinal bleeding.RESULTSTwelve studies from East Asia or Southeast Asia and 441450 patients were included. Dabigatran, rivaroxaban, and apixaban were associated with a significant reduction in the incidence of ischemic stroke [hazard ratio (HR) = 0.78, 95% confidence interval (CI): 0.65-0.94; HR = 0.79, 95%CI: 0.74-0.85, HR = 0.70, 95%CI: 0.62-0.78; respectively], all-cause mortality (HR = 0.68, 95%CI: 0.56-0.83; HR = 0.66, 95%CI: 0.52-0.84; HR = 0.66, 95%CI: 0.49-0.90; respectively), and major bleeding (HR = 0.61, 95%CI: 0.54-0.69; HR = 0.70, 95%CI: 0.54-0.90; HR = 0.58, 95%CI: 0.43-0.78; respectively) compared to warfarin.CONCLUSIONDabigatran, rivaroxaban, and apixaban appear to be superior to warfarin in both efficacy and safety in Asians with non-valvular AF.     

SDC2基因甲基化对结直肠癌诊断价值的Meta分析

目的通过Meta分析方法评价多配体蛋白聚糖2(Syndecan-2,SDC2)基因甲基化作为生物标志物诊断结直肠癌(colorectal cancer,CRC)的价值。方法计算机检索PubMed、Cochrane Library、Embase、Web of Science、CBM、万方、知网、维普数据库,查找建库至2020年9月1日有关SDC2基因甲基化与CRC的研究,按照纳入及排除标准严格筛选文献,提取信息并依据QUADAS-2准则对文献进行质量评价。检验阈值效应及非阈值效应,计算合并灵敏度(sensitivity,Sen)、特异度(specificity,Spe)、阳性似然比(positive likelihood ratio,PLR)、阴性似然比(negative likelihood ratio,NLR)、诊断比值比(diagnostic odds ratio,DOR),绘制综合受试者工作特征曲线(summary receiver operating characteristic curve,SROC)并计算曲线下面积(area under curve,AUC)。采用亚组分析、敏感性分析探讨研究异质性。Deek’s漏斗图用以评价纳入文献偏倚大小。结果共纳入符合标准的文献11篇,包括1419例CRC患者和1363名健康对照者。SDC2甲基化诊断CRC的Sen_合并=0.77(95%CI:0.65~0.86),Spe_合并=0.94(95%CI:0.92~0.96),PLR_合并=14.17(95%CI:9.14~21.99),NLR_合并=0.24(95%CI:0.16~0.38),DOR_合并=58.28(95%CI:28.25~120.20),AUC=0.95(95%CI:0.93~0.97)。亚组分析结果显示,粪便SDC2甲基化对CRC的诊断价值(DOR_合并=84.23,95%CI:55.72~127.35)明显高于血液组(DOR_合并=33.27,95%CI:8.05~137.56)。亚洲地区SDC2甲基化对CRC的诊断价值(DOR_合并=76.44,95%CI:56.03~104.30)明显高于非亚洲地区(DOR_合并=16.50,95%CI:2.97~91.52)。Deek’s漏斗图提示,本研究不存在显著发表偏倚(P=0.840)。结论SDC2基因甲基化对CRC具有极高的诊断价值。     

Comparison of diagnostic efficacy between CLE,tissue sampling,and CLE combined with tissue sampling for undetermined pancreaticobiliary strictures: a meta-analysis

Objective: The accurate diagnosis of undetermined pancreaticobiliary strictures remains challenging. Current ERCP-guided tissue sampling methods are of low sensitivity. Confocal laser endomicroscopy (CLE) is a new procedure and allows real optical biopsies that may improve the diagnosis of undetermined pancreaticobiliary strictures. The aim of this meta-analysis was to determine the diagnostic yield of CLE, tissue sampling, and CLE combined with tissue sampling for undetermined pancreaticobiliary strictures.

Method: Pubmed, Embase, and the Cochrane Library database were reviewed for relevant studies. Pooled estimates of sensitivity and specificity with 95% confidence intervals (CIs) were calculated using the random-effects meta-analysis model. The summary receiver-operating characteristic (SROC) curve was constructed, and the area under the receiver operating characteristic curve (AUC) was calculated.

Results: Twelve studies involving 591 patients were enrolled in our analysis. The overall sensitivity and the specificity estimate of CLE for discriminating benign and malignant pancreaticobiliary strictures were 87% (95%CI, 83–91%) and 76% (95%CI, 70–81%), respectively. The AUC to assess the diagnostic efficacy was 0.8705. For tissue sampling, the overall sensitivity and the specificity estimate were 64% (95%CI, 57–70%) and 94% (95%CI, 90–97%), respectively. The AUC to assess the diagnostic efficacy was 0.8040. A combination of both methods increased the sensitivity (93%; 95%CI, 88–96%) with a specificity of 82% (95%CI, 74–89%). The AUC to assess the diagnostic efficacy was 0.9377. There was no publication bias by Deeks’ Funnel Plot with p?=?.936.

Conclusions: Compared with tissue sampling, CLE may increase the sensitivity for the diagnosis of malignant pancreaticobiliary strictures. A combination of both can effectively diagnose malignant pancreaticobiliary strictures.     

A panel of circulating miRNAs as diagnostic biomarkers for screening multiple myeloma: a systematic review and meta‐analysis

Circulating microRNAs (miRNAs) have been proved to be effective diagnostic markers for multiple myeloma (MM). The meta‐analysis was aimed to evaluate the diagnostic value of related miRNAs. Multiple databases (PubMed, Web of Science, EMBASE, Cochrane Library, CBM, and CNKI) were systematically searched for available studies up to March 2016. All data were analyzed with the help of software revman 5.3 and metadisc 1.4. The eligible articles’ quality was estimated by QUADAS‐2, and pooled parameters were acquired with the bivariate random‐effects meta‐analysis model. Subgroup analysis and meta‐regression were conducted to explore the heterogeneity of studies included. After steps of screening, seven qualified literatures were selected. They consisted of 22 studies that included 486 newly diagnosed MM patients and 292 healthy controls. Summary receiver operating characteristic (SROC) analyses of all miRNAs showed an area under the curve (AUC) of 0.86 (95%CI, 0.82–0.91). Together with the AUC, the positive likelihood ratio‐PLR 4.45 (95%CI, 3.28–6.04), negative likelihood ratio‐NLR 0.29 (95%CI, 0.24–0.35), and diagnostic odds ratio‐DOR 17.59 (95%CI, 11.26–27.4) confirmed that circulating miRNAs possessed relatively high diagnostic value in discriminating MM patients from healthy controls. For miRNAs combined together, miRNA‐1308/miRNA‐720 had the highest sensitivity 0.96 (95%CI, 0.79–1.00) and specificity 0.92 (95%CI 0.64–1.0). The subgroup and meta‐regression analyses also showed that miRNAs profiling was the sole source of heterogeneity, and the diagnostic accuracy of combined miRNAs was 6.02 times higher than single one. Combined circulating miRNAs in serum or plasma may be highly effective biomarker for diagnosis of MM.     

FeNO检测对中国人群激素敏感性咳嗽诊断价值的Meta分析

目的评价呼出气一氧化氮(FeNO)检测在中国人群激素敏感性咳嗽(CRC)患者中的诊断价值,为临床治疗提供循证依据。方法计算机检索中国生物医学文献数据库(CBM)、中国学术期刊全文数据库(CNKI)、重庆维普中文科技期刊全文数据库(VIP)、万方科技期刊全文及硕士论文数据库(Wanfangdate)以及Cochrane library、PubMed、Web of science和Embase数据库,按纳入排除标准选择文献,结局指标是FeNO值、敏感度和特异度等。采用统计学分析软件RevMan5.3、stata12.0进行meta分析。结果经筛选有13篇文献入选,结果显示CRC患者FeNO水平明显高于非激素敏感性咳嗽(NCRC)患者[MD=20.44,95%CI:(15.29~25.59),P<0.05],亚组分析发现咳嗽变异性哮喘(CVA)患者FeNO水平明显高于其他慢性咳嗽患者,差异有统计学意义[MD=30.03,95%CI:(21.43~38.63),P<0.05];嗜酸粒细胞性支气管炎(EB)患者FeNO水平明显高于其他慢性咳嗽患者,差异也具有统计学意义[MD=12.32,95%CI:(9.02~15.61),P<0.05]。进一步合并后发现FeNO对慢性咳嗽人群中CRC诊断的敏感度为0.74(95%CI:0.67~0.80),特异度为0.87(95%CI:0.83~0.91),阳性似然比为5.8(95%CI:4.3~7.8),阴性似然比为0.30(95%CI:0.23~0.38),诊断优势比为20(95%CI:12~31),集成受试者工作特征曲线(SROC)曲线下面积为0.89(95%CI:0.86~0.91)。其中对慢性咳嗽人群中CVA诊断的敏感度为0.80(95%CI:0.74~0.84),特异度为0.85(95%CI:0.80~0.90),阳性似然比为5.5(95%CI:3.8~7.9),阴性似然比为0.24(95%CI:0.18~0.32),诊断优势比为23(95%CI:13~42),SROC曲线下面积为0.89(95%CI:0.86~0.92)。结论现有临床研究证据显示,在中国人群中,CRC患者FeNO水平明显高于其他病因的慢性咳嗽患者,且FeNO对诊断CRC患者具有重要的临床意义。可为临床上FeNO值高的慢性咳嗽患者提供一种经验性治疗的策略。但因研究质量及研究样本的局限性,还需大规模的研究加以论证。     

Colonic lesion characterization in inflammatory bowel disease: A systematic review and meta-analysis

AIM To perform a systematic review and meta-analysis for the diagnostic accuracy of in vivo lesion characterization in colonic inflammatory bowel disease(IBD), using optical imaging techniques, including virtual chromoendoscopy(VCE), dye-based chromoendoscopy(DBC), magnification endoscopy and confocal laser endomicroscopy(CLE). METHODS We searched Medline, Embase and the Cochrane library. We performed a bivariate meta-analysis to calculate the pooled estimate sensitivities, specificities, positive and negative likelihood ratios(+LHR,-LHR), diagnostic odds ratios(DOR), and area under the SROC curve(AUSROC) for each technology group. A subgroup analysis was performed to investigate differences in real-time nonmagnified Kudo pit patterns(with VCE and DBC) and real-time CLE.RESULTS We included 22 studies [1491 patients; 4674 polyps, of which 539(11.5%) were neoplastic]. Real-time CLE had a pooled sensitivity of 91%(95%CI: 66%-98%), specificity of 97%(95%CI: 94%-98%), and an AUSROC of 0.98(95%CI: 0.97-0.99). Magnification endoscopy had a pooled sensitivity of 90%(95%CI: 77%-96%)and specificity of 87%(95%CI: 81%-91%). VCE had a pooled sensitivity of 86%(95%CI: 62%-95%) and specificity of 87%(95%CI: 72%-95%). DBC had a pooled sensitivity of 67%(95%CI: 44%-84%) and specificity of 86%(95%CI: 72%-94%). CONCLUSION Real-time CLE is a highly accurate technology for differentiating neoplastic from non-neoplastic lesions in patients with colonic IBD. However, most CLE studies were performed by single expert users within tertiary centres, potentially confounding these results.