Diagnostic accuracy of endostatin for malignant pleural effusion: A clinical study and meta-analysis

Background. The diagnosis of malignant pleural effusion (MPE) remains a clinical challenge. Many studies suggest that endostatin is a potential marker for MPE. This study aimed to determine the diagnostic value of endostatin with respect to MPE and to summarize the overall diagnostic performance of endostatin via a meta-analysis. Methods. Pleural effusion samples from patients with both malignant and nonmalignant disease were collected, and the pleural levels of endostatin and carcino-embryonic antigen (CEA) were subsequently measured. The diagnostic performances of endostatin and CEA were analyzed via standard receiver operator characteristic curve analysis methods, using the AUC as a measure of accuracy. The overall diagnostic accuracy of endostatin for MPE was summarized through a bivariate meta-analysis with standard method recommended. Results. Fifty-two patients with MPEs and 64 patients with benign pleural effusions (BPEs) were included this study. Pleural endostatin levels were significantly increased in the setting of MPE compared with BPE (104.78 ± 64.58 vs 56.81 ± 28.84 ng/ml; p < 0.001). Using a cutoff value of 79.7 ng/ml, the sensitivity and specificity of endostatin in diagnosing MPE were shown to be 51.92% and 85.94%, respectively, and the AUC was 0.747. The combination of endostatin and CEA enhanced diagnostic performance with respect to MPE. In addition to this study, another eight studies were included in this meta-analysis. The pooled diagnostic estimates were 0.69 for sensitivity and 0.78 for specificity. The positive likelihood ratio and negative likelihood ratio for endostatin were 3.16 and 0.40, respectively. The diagnostic odds ratio was 7.89, and the AUC of the summary receiver operator characteristic curve was 0.79. Conclusion. Pleural levels of endostatin are increased in the setting of MPE. However, endostatin exhibits a limited efficacy for the diagnosis of MPE and shows a relatively low sensitivity. The assessment of endostatin in combination with CEA may enhance diagnostic accuracy with respect to MPE.     

Diagnostic value of periostin in lung cancer‐related malignant pleural effusion

BackgroundPeriostin (POSTN) is an extracellular matrix protein that is overexpressed in lung cancer and is considered an effective diagnostic and prognostic biomarker for lung cancer. The purpose of this study was to investigate the diagnostic performance of POSTN and to further evaluate the diagnostic value of POSTN combined with carcinoembryonic antigen (CEA) and cancer ratio [CR: serum lactate dehydrogenase (LDH)/pleural effusion adenosine deaminase (PE ADA)] in lung cancer‐related malignant PE (MPE).MethodsA total of 108 patients with PE, including 54 with lung cancer and 54 with benign lung disease, were enrolled in this study. The POSTN levels of PE and serum were detected using an enzyme‐linked immunosorbent assay. Information on the expression of PE and serum CEA, serum LDH, and PE ADA was collected from medical records.ResultsThe levels of PE POSTN in MPE of patients with lung cancer were significantly higher than those in patients with benign PE (p < 0.0001). The receiver operating characteristic (ROC) curve indicated that the diagnostic sensitivity and specificity of PE POSTN for lung cancer‐related MPE were respectively 77.78% and 68.52% when the cutoff value was determined to be 53.45 ng/ml. The ROC curve analysis demonstrated that PE POSTN has a high diagnostic value in MPE associated with lung cancer [area under the curve (AUC) = 0.764], and the combination of PE POSTN, PE CEA, and CR can improve the diagnostic accuracy of lung cancer‐related MPE (AUC = 0.948).ConclusionPOSTN can be used as a potential marker for lung cancer‐related MPE diagnosis.     

Diagnostic performance of CTLA-4, carcinoembryonic antigen and CYFRA 21-1 for malignant pleural effusion

Objectives: The diagnosis of malignant pleural effusion (MPE) remains a clinical challenge. As a negative regulator of T-cell activation, cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) has been associated with many malignant diseases. However, there is limited data about the relationship between CTLA-4 and MPE. The present study aims to investigate whether CTLA-4 levels may correlate with presence of MPE and to assess its potential diagnostic accuracy relative to that of the established markers carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA21–1).

Methods: Pleural effusion samples were collected from 36 patients with MPE and 48 patients with benign pleural effusion (BPE). Pleural levels of CTLA-4 were measured by ELISA; levels of CEA and CYFRA 21-1, by electrochemiluminescence immunoassay. Receiver operating characteristic curves were calculated to evaluate the ability of CTLA-4, CEA and CYFRA 21-1 to differentiate MPE from BPE.

Results: Pleural levels of CTLA-4 were significantly higher in MPE than in BPE patients (471.73 ± 378.86 vs. 289.22 ± 173.67 pg/ml, p = 0.004). At a cut-off value of 351.25 pg/ml, the sensitivity and specificity of CTLA-4 in diagnosing MPE were 58.30% and 83.30%, respectively, and the area under the curve was 0.72. Pleural levels of CEA and CYFRA 21-1 were also higher in MPE. Using the combination of CTLA-4, CEA and CYFRA 21-1 increased diagnostic sensitivity to 88.89% and the area under the curve to 0.92.

Conclusion: The results of this preliminary study suggest that increased levels of CTLA-4 correlate with MPE, and that CTLA-4 may have some diagnostic usefulness when used in combination with conventional tumor markers such as CEA and CYFRA 21-1. These results justify larger, more rigorous studies to validate our findings.     

超声及MRI诊断妊娠期阑尾炎:Meta分析

目的采用Meta分析方法评价超声、MRI对妊娠期阑尾炎的诊断效能。方法检索Cochrane Library、Pubmed、Embase、中国知网、万方医学网和维普数据库中关于超声和/或MRI诊断妊娠期阑尾炎的文献,检索时间从建库至2019年9月。依据纳入及排除标准筛选文献,并进行质量评价。采用Stata15.0、Meta-Disc1.4软件进行统计分析。结果最终纳入19篇文献(2379例疑诊妊娠期阑尾炎患者),仅超声诊断妊娠期阑尾炎文献4篇,仅MRI诊断11篇,同时采用超声及MRI诊断4篇。超声对妊娠期阑尾炎的诊断敏感度和特异度分别为0.68[95%CI(0.60,0.75)]和0.98[95%CI(0.95,0.99)],诊断比值比及受试者工作特征(ROC)曲线下面积(AUC)分别为12.53[95%CI(5.78,27.19)]和0.86。MRI对妊娠期阑尾炎的诊断敏感度和特异度分别为0.95[95%CI(0.91,0.98)]和0.98[95%CI(0.97,0.98)],诊断比值比及AUC分别为331.84[95%CI(161.42,682.16)]和0.99,其AUC明显高于超声(Z=7.41,P<0.001)。结论MRI对妊娠期阑尾炎的诊断效能明显高于超声。     

探讨渗出性胸腔积液ADA、CEA对良恶性胸腔积液的诊断价值

目的 探究渗出性胸腔积液腺苷脱氨酶(ADA)、癌胚抗原(CEA)对良恶性胸腔积液的诊断价值.方法 选择2017年1月至2020年8月本院收治的106例渗出性胸腔积液患者,将患者分为恶性组(n=36)和良性组(n=70).对两组患者胸水ADA、胸水CEA、血清CEA水平进行比较,采用单因素、多因素Logistic回归分析...     

ROC曲线评价腺苷脱氨酶在结核性、恶性胸腔积液的鉴别诊断价值

目的探讨腺苷脱氨酶（ADA）测定在结核性胸腔积液及恶性胸腔积液患者的鉴别诊断价值。方法应用受试者工作曲线（ROC）对176例结核性胸腔积液患者及162例恶性胸腔积液患者的胸腔积液ADA、血清ADA、胸腔积液ADA/血清ADA检测结果进行分析评价。结果 （1）血清ADA在两组资料间差异无统计学意义（P〉0.05）,胸腔积液ADA、胸腔积液ADA/血清ADA在两组资料间比较差异均有统计学意义（P〈0.05）,二者的敏感性分别为92.9%、71.9%,特异性分别为94.7%、100%,准确度分别为93.4%、78.6%。（2）胸腔积液ADA、胸腔积液ADA/血清ADA在ROC曲线下面积分别为0.942、0.909。胸腔积液ADA、胸腔积液ADA/血清ADA对结核性胸腔积液的临床诊断临界点分别为16.4U/L、2.57。结论胸腔积液ADA在结核性和恶性胸腔积液的鉴别中具有重要的临床价值,可作为结核性胸腔积液的生物标志物。     

Accuracy of point-of-care ultrasound and radiology-performed ultrasound for intussusception: A systematic review and meta-analysis

ObjectiveIt is unclear whether point-of-care ultrasound (POCUS) by emergency medicine physicians is as accurate as radiology-performed ultrasound (RADUS). We aim to summarize the diagnostic accuracy of ultrasonography for intussusception and to compare the performance between POCUS and RADUS.MethodsDatabases were searched from inception through February 2018 using pre-defined index terms. Peer-reviewed primary studies that investigated the diagnostic accuracy of ultrasound for intussusception in children were included. The study is reported using Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA). Meta-analysis of the diagnostic accuracy of ultrasound for intussusception was conducted using the random-effects bivariate model. Subgroup analysis (POCUS vs RADUS) was also performed. Meta-regression was utilized to determine if the diagnostic accuracy between POCUS and RADUS was significantly different.ResultsThirty studies (n = 5249) were included in the meta-analysis. Ultrasonography for intussusception has a sensitivity: 0.98 (95% CI: 0.96–0.98), specificity: 0.98 (95% CI: 0.95–0.99), positive likelihood ratio: 43.8 (95% CI: 18.0–106.7) and negative likelihood ratio: 0.03 (95% CI: 0.02–0.04), with an area under ROC (AUROC) curve of 0.99 (95% CI: 0.98–1.00). Meta-regression suggested no significant difference in the diagnostic accuracy for intussusception between POCUS and RADUS (AUROC: 0.95 vs 1.00, p = 0.128).ConclusionsCurrent evidence suggested POCUS has a high diagnostic accuracy for intussusception not significantly different from that of RADUS.     

Diagnostic accuracy of ultrasound for upper extremity fractures in children: A systematic review and meta-analysis

ObjectiveUltrasound has an excellent diagnostic accuracy for fractures that is reportedly comparable to plain radiographs. We aim to summarize the diagnostic accuracy of ultrasound for upper extremity fractures in children.MethodsDatabases were searched from inception through November 2019 using pre-defined index terms, including “ultrasound,” “fractures of upper extremities” and “children”. The study is reported using Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA). Meta-analysis of the diagnostic accuracy of ultrasound for fractures was conducted using the random-effects bivariate model. Subgroup analysis of fracture site (elbow vs non-elbow fractures) was also performed. Meta-regression was performed to determine if the site of fracture affected the diagnostic accuracy.ResultsThirty-two studies were identified in the meta-analysis. Ultrasound for fractures of the upper extremities has a sensitivity: 0.95 (95% CI: 0.93–0.97), specificity: 0.95 (95% CI: 0.91–0.98), positive likelihood ratio: 21.1 (95% CI: 10.8–41.5) and negative likelihood ratio: 0.05 (95% CI: 0.03–0.07), with an area under ROC (AUROC) curve of 0.98 (95% CI: 0.97–0.99). Subgroup analysis for elbow fracture showed ultrasound has a sensitivity: 0.95 (95% CI: 0.86–0.98), specificity: 0.87 (95% CI: 0.76–0.94), positive likelihood ratio: 7.3 (95% CI: 3.7–14.4) and negative likelihood ratio: 0.06 (95% CI: 0.02–0.16), with an AUROC of 0.96 (95% CI: 0.94–0.97). Meta-regression suggested the fracture sites would affect diagnostic accuracy of ultrasound (elbow vs non-elbow, p < 0.01).ConclusionsCurrent evidence suggests ultrasound has excellent diagnostic accuracy for non-elbow upper extremity fractures in children, serving as an alternative diagnostic modality to plain radiographs.     

Rapid urinary trypsinogen-2 test in the early diagnosis of acute pancreatitis: A meta-analysis

ObjectivesUrinary trypsinogen-2 has been implicated as a promising biomarker for the early diagnosis of acute pancreatitis (AP). The meta-analysis was used to establish the overall accuracy of urinary trypsinogen-2 test for diagnosing AP.MethodsBased on comprehensive searches of the PubMed and Embase databases, we identified and abstracted outcome data from all articles evaluating the diagnostic value of urinary trypsinogen-2. A summary estimate for sensitivity, specificity, 95% confidence region and 95% prediction region was calculated using the bivariate random-effects approach.ResultsThe meta-analysis included 13 studies (2342 patients, the proportion of severe AP from 13.21% to 30.00%). Overall, the pooled sensitivity was 82.3% (95%CI 79.3%–85.1%) and specificity was 93.5% (95%CI 92.2%–94.6%). The diagnostic odds ratios (DOR) was 85.23 (95%CI 40.14–180.99). The area under the summary ROC curve (AUC) was 0.9673.ConclusionThe urinary trypsinogen-2 test is a reliable and rapid method for the early diagnosis of AP.     

MicroRNAs as potential biomarkers for the diagnosis of inflammatory bowel disease: a systematic review and meta-analysis

ObjectiveThe clinical importance of aberrantly expressed microRNAs (miRNAs) in diagnosing inflammatory bowel disease (IBD) has not been well established, so was investigated in this systematic review and meta-analysis.MethodsArticles in online databases from inception to March 17, 2021 were retrieved. Random effects meta-analysis was used to obtain sensitivity, specificity, positive (PLRs) and negative likelihood ratios (NLRs), diagnostic odds ratios (DORs), and areas under the curve (AUC) with 95% confidence intervals (CI) for IBD diagnosis.ResultsOf 117 studies reporting altered miRNA expression in IBD included in the systematic review, 15 involving 937 patients with IBD and 707 controls, 22 miRNAs, and two miRNA panels were eligible for meta-analysis. Pooled analyses showed a moderate diagnostic accuracy for miRNAs in the IBD diagnosis, with a sensitivity of 0.80 (95% CI: 0.79–0.82), specificity of 0.84 (95% CI: 0.82–0.86), DOR of 21.19 (95% CI: 13.90–32.31), and AUC of 0.89. Subgroup analyses revealed a better performance in patients with ulcerative colitis (AUC, 0.93) than Crohn’s disease (AUC, 0.84). Consistent upregulation of miR-21, miR-16, and miR-192 in blood with a high-moderate diagnostic accuracy was found in at least two studies.ConclusionsThese findings suggest miRNAs are credible diagnostic biomarkers in IBD.     

声脉冲辐射力成像鉴别诊断良、恶性BI-RADS 4级乳腺肿块

目的 评价声脉冲辐射力成像(ARFI)在乳腺影像学报告及数据系统(BI-RADS)4级乳腺肿块良、恶性诊断中的价值。 方法 用ARFI对68例共75个常规超声诊断为BI-RADS 4级的乳腺肿块进行成像,测量声触诊组织成像(VTI)模式下肿块面积与常规二维超声肿块面积比值(AR),并测量声触诊量化成像(VTQ)模式下肿块剪切波速度(SWV);以病理结果(恶性34个,良性41个)为金标准,构建ROC曲线,评价ARFI的2种成像模式对BI-RADS 4级乳腺肿块的诊断价值。 结果 良、恶性BI-RADS 4级乳腺肿块的AR值差异有统计学意义(P<0.05),ROC曲线下面积(AUC)为0.851,敏感度、特异度、准确率分别为82.40%、80.50%、81.30%。良、恶性BI-RADS 4级乳腺肿块的SWV值差异有统计学意义(P<0.05)。SWV值AUC为0.861,敏感度、特异度、准确率分别为85.30%、85.40%、85.30%。二者AUC差异无统计学意义(Z=1.47,P>0.05)。二者联合诊断的敏感度、特异度、准确率分别为88.20%、87.80%、88.00%。 结论 ARFI对鉴别BI-RADS 4级乳腺肿块的良、恶性具有较高价值;联合应用VTI和VTQ可以提高诊断效能。     

弹性成像5分评分法与应变率比值法鉴别诊断肝脏良恶性病变

目的 比较弹性成像5分评分法与应变率比值法对肝脏良恶性病变的鉴别诊断价值。 方法 对165例患者(共183个肝脏局灶性病变)进行肝脏弹性成像检查,分别对病灶进行弹性评分及应变率比值测定。以病理结果作为金标准,构建ROC曲线并计算曲线下面积,分别计算弹性评分法和应变率比值用于鉴别诊断肝脏良恶性肿瘤的敏感度、特异度、准确率、阳性预测值和阴性预测值;比较两种方法对肝脏局灶性病变的诊断效能。 结果 采用应变率比值鉴别诊断肝脏良恶性病灶时,曲线下面积为0.85;采用弹性评分时,曲线下面积为0.82,二者差异无统计学意义(P=0.14)。应变率比值诊断肝脏良恶性肿瘤的敏感度、特异度、准确率、阳性预测值及阴性预测值分别为71.26%(62/87)、91.67%(88/96)、81.97%(150/183)、88.57%(62/70)、77.88%(88/113);弹性评分诊断肝脏恶性肿瘤的敏感度、特异度、准确率、阳性预测值及阴性预测值分别为88.51%(77/87)、60.42%(58/96)、73.77%(135/183)、66.96%(77/115)、85.29%(58/88)。应变率比值法的特异度高于弹性评分法(P<0.05),但其敏感度较低(P<0.05),二者准确率差异无统计学意义(P>0.05),二者诊断能力的差异主要体现在弹性评分为3分的病灶中。 结论 应用弹性成像鉴别诊断肝脏局灶性病变的良恶性时,应变率比值法及弹性评分法各有优缺点,在临床应用中应结合具体情况选择合理方法。     

Logistic回归和ROC曲线分析多种肿瘤标志物在鉴别良恶性胸水中的应用价值

目的:应用Logistic回归和ROC曲线探讨癌胚抗原(CEA)、鳞癌抗原(SCC)、神经特异性烯醇化酶(NSE)和细胞角蛋白19片段(CYFRA21-1)在鉴别良恶性胸水中的应用价值。方法:应用化学发光微粒子免疫测定法和电化学发光免疫测定法对24例肺癌患者、32例良性肺部疾病患者的胸水标本进行4种肿瘤标志物测定,通过ROC曲线分析CEA、CYFRA21-1、NSE、SCC及各种Logistic回归结果的ROC曲线下面积(AUC)值。结果:肺癌患者-良性肺部疾病患者胸水中,除SCC外其余3种肿瘤标志物差异均有显著性(P<0.05)。CEA的AUC要高于CYFRA21-1,而CYFRA21-1的AUC要高于NSE,NSE的AUC要高于SCC,而CEA、CYFRA21-1、NSE三者联合诊断的AUC要高于其中任意单一检查的AUC。结论:检测CEA、CYFRA21-1和NSE3种肿瘤标志物对诊断和鉴别诊断良、恶性肺部疾病有重要临床价值。作为一种统计手段,ROC分析中结合Logistic回归模型简单有效,适用于多指标联合诊断试验的分析评价。     

Monocytes subtypes from pleural effusion reveal biomarker candidates for the diagnosis of tuberculosis and malignancy

BackgroundPleural effusion is a common clinical condition caused by several respiratory diseases, including tuberculosis and malignancy. However, rapid and accurate diagnoses of tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) remain challenging. Although monocytes have been confirmed as an important immune cell in tuberculosis and malignancy, little is known about the role of monocytes subpopulations in the diagnosis of pleural effusion.MethodsPleural effusion samples and peripheral blood samples were collected from 40 TPE patients, 40 MPE patients, and 24 transudate pleural effusion patients, respectively. Chemokines (CCL2, CCL7, and CX3CL1) and cytokines (IL‐1β, IL‐17, IL‐27, and IFN‐γ) were measured by ELISA. The monocytes phenotypes were analyzed by flow cytometry. The chemokines receptors (CCR2 and CX3CR1) and cytokines above in different monocytes subsets were analyzed by real‐time PCR. Receiver operating characteristic curve analysis was performed for displaying differentiating power of intermediate and nonclassical subsets between tuberculous and malignant pleural effusions.ResultsCCL7 and CX3CL1 levels in TPE were significantly elevated in TPE compared with MPE and transudate pleural effusion. Cytokines, such as IL‐1β, IL‐17, IL‐27, and IFN‐γ, in TPE were much higher than in other pleural effusions. Moreover, CD14⁺CD16⁺⁺ nonclassical subset frequency in TPE was remarkably higher than that in MPE, while CD14⁺⁺CD16⁺ intermediate subset proportion in MPE was found elevated. Furthermore, CX3CL1‐CX3CR1 axis‐mediated infiltration of nonclassical monocytes in TPE was related to CX3CL1 and IFN‐γ expression in TPE. Higher expression of cytokines (IL‐1β, IL‐17, IL‐27, and IFN‐γ) were found in nonclassical monocytes compared with other subsets. Additionally, the proportions of intermediate and nonclassical monocytes in pleural effusion have the power in discriminating tuberculosis from malignant pleural effusion.ConclusionsCD14 and CD16 markers on monocytes could be potentially used as novel diagnostic markers for diagnosing TPE and MPE.     

Role of circulating tumor cells in diagnosis of lung cancer: a systematic review and meta-analysis

ObjectiveWe systematically reviewed the literature relating to the diagnostic accuracy of circulating tumor cells (CTCs) for the clinical determination of lung cancer.MethodsThis meta-analysis aimed to evaluate the diagnostic accuracy of CTCs for the clinical determination of lung cancer. The PubMed, Embase, Cochrane Library, and Web of Science databases were searched for relevant studies up to 31 May 2020. The numbers of patients with true positive, false positive, false negative, and true negative results were extracted from each individual study. Pooled sensitivity, specificity, and area under the curve values were calculated with 95% confidence intervals (CI).ResultsTwenty-one studies with 3997 subjects met the inclusion criteria. The overall diagnostic accuracy was assessed. The pooled sensitivity and specificity were 0.72 (95%CI: 0.65–0.79) and 0.96 (95%CI: 0.91–0.98), respectively, and the pooled positive and negative likelihood ratios were 16.86 (95%CI: 7.65–37.12) and 0.29 (95%CI: 0.23–0.37), respectively. The combined diagnostic odds ratio was 58.12 (95%CI: 24.82–136.09).ConclusionThis meta-analysis indicated that CTCs had good diagnostic value for detecting lung cancer.     

Diagnostic value of neutrophil CD64 combined with CRP for neonatal sepsis: A meta-analysis

BackgroundSepsis is the leading cause of morbidity and mortality in newborns. CD64 combined with c-reactive protein (CRP) could improve the sensitivity and specificity of neonatal sepsis diagnosis, but the results were still controversial. Therefore, this meta-analysis was conducted to clarify the importance of CD64 combined with CRP in the diagnosis of neonatal sepsis.MethodsThe researches published as of December 24, 2018 were comprehensively searched in PubMed, Embase (included Embase and Medline), the Cochrane Library and Web of Science. Totally, 8 articles were included, involving 1114 objects. Statistical calculations were performed using Stata14.0 and Review Manager 5.3.ResultsThe diagnostic accuracy of all included studies was pooled as follows: sensitivity, 0.95 (95% CI: 0.86–0.98); specificity, 0.86 (95% CI: 0.74–0.93); positive likelihood ratio (PLR), 6.8 (95% CI: 3.50–13.20); negative likelihood ratio (NLR), 0.06 (95% CI: 0.02–0.18); diagnostic odds ratio (DOR), 118.0 (95% CI: 25.00–549.00), and the area under the curve (AUC) was 0.96 (95% CI: 0.94–0.97). It was found that heterogeneity was not caused by threshold effect (P = 0.16), but the results of sensitivity (I² = 87.57%) and specificity (I² = 89.07%) analyses indicated significant heterogeneity between studies.ConclusionsThe combined application of CD64 and CRP improved the accuracy of neonatal sepsis diagnosis.     

肿瘤标志物在鉴别伴有胸水的良恶性肺部疾病中的应用价值

目的:通过对胸水和血清中糖类抗原125(CA125)、糖类抗原19-9(CA19-9)、癌胚抗原(CEA)、鳞癌抗原(SCC)、神经特异性烯醇化酶(NSE)和细胞角蛋白19片段(CYFRA21-1)的检测及胸水脱落细胞学检查,探讨各指标在对伴胸水的肺部良、恶性疾病鉴别诊断中的价值。方法:应用化学发光微粒子免疫测定法和电化学发光免疫测定法对26例肺癌患者、41例良性肺部疾病患者的胸水和血清标本及30名正常体检者的血清标本进行6种肿瘤标志物测定,同时对患者胸水标本进行脱落细胞学检查,并根据受试者工作特性(ROC)曲线建立合理的临床判断临界值。结果:胸水CEA及血清CYFRA21-1对肺癌的辅助诊断价值最高。CEA含量在胸水与血清中的比值(P/S)与其他5种肿瘤标志物P/S值相比其辅助诊断价值最高。胸水标本脱落细胞学检查的灵敏度和特异度分别为69.23%和100%;而其与胸水CEA联合检测后灵敏度和特异度分别为100%和97.56%。结论:检测胸水CEA、血清CYFRA21-1对鉴别良、恶性肺部疾病有重要价值,胸水CEA与脱落细胞学联合检测可提高辅助诊断的灵敏度。     

High diagnostic value of miRNAs for NSCLC: quantitative analysis for both single and combined miRNAs in lung cancer

BackgroundMicroRNAs (miRNAs) are good candidates as biomarkers for Lung cancer (LC). The aim of this article is to figure out the diagnostic value of both single and combined miRNAs in LC.MethodsNormative meta-analysis was conducted based on PRISMA. We assessed the diagnostic value by calculating the combined sensitivity (Sen), specificity (Spe), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR) and the area under the curve (AUC) of single and combined miRNAs for LC and specific subgroups.ResultsA total of 80 qualified studies with a total of 8971 patients and 10758 controls were included. In non-small cell lung carcinoma (NSCLC), we involved 20 single-miRNAs and found their Sen, Spe and AUC ranged from 0.52-0.81, 0.66-0.88, and 0.68-0.90, respectively, specially, miR-19 with the maximum Sen, miR-20 and miR-10 with the highest Spe as well as miR-17 with the maximum AUC. Additionally, we detected miR-21 with the maximum Sen of 0.74 [95%CI: 0.62-0.83], miR-146 with the maximum Spe and AUC of 0.93 [95%CI: 0.79-0.98] and 0.89 [95%CI: 0.86-0.92] for early-stage NSCLC. We also identified the diagnostic power of available panel (miR-210, miR-31 and miR-21) for NSCLC with satisfying Sen, Spe and AUC of 0.82 [95%CI: 0.78-0.84], 0.87 [95%CI: 0.84-0.89] and 0.91 [95%CI: 0.88-0.93], and furtherly constructed 2 models for better diagnosis.ConclusionsWe identified several single miRNAs and combined groups with high diagnostic power for NSCLC through pooled quantitative analysis, which shows that specific miRNAs are good biomarker candidates for NSCLC and further researches needed.     

The accuracy of glial fibrillary acidic protein in acute stroke differential diagnosis: A meta-analysis

Abstract

We performed a systematic review of English-language studies published during the past three decades to investigate the diagnostic performance of serum glial fibrillary acidic protein (GFAP) for the differential diagnosis of acute stroke, including intracerebral hemorrhage (ICH) and cerebral ischemia (CI). QUADAS tools were used to evaluate the quality of the study. Performance characteristics (diagnostic sensitivity, specificity, and other measures of accuracy) were pooled and examined using fixed-effects models. Four studies met the inclusion criteria, and included 109 patients with ICH and 381 patients with CI. The summary estimates for GFAP in the ICH diagnoses had a diagnostic sensitivity of 0.80 (95% confidence interval 0.71–0.88), a specificity of 0.97 (95% confidence interval, 0.94–0.98), and a diagnostic odds ratio (DOR) of 119.55 (95% confidence interval: 51.75–276.19). The area under curve (AUC) and Q value for the sROC curves were 0.97 and 0.92, respectively. Therefore, GFAP showed high diagnostic accuracy for acute stroke differential diagnosis.     

胸膜厚度、腺苷脱氨酶、胸腔积液癌胚抗原/血清癌胚抗原比值对恶性与结核性胸腔积液的鉴别诊断价值

目的评价胸膜厚度、腺苷脱氨酶（ADA）、胸腔积液癌胚抗原/血清癌胚抗原（胸腔积液CEA/血清CEA）比值在恶性与结核性胸腔积液的鉴别诊断中的价值。方法选择经胸腔镜病理组织检查确诊胸腔积液患者91例,按病理结果分为2组,结核性胸膜炎组（结核性组）43例和恶性胸腔积液组（恶性组）48例。对2组患者胸腔积液CEA/血清CEA比值、ADA和CT影像学上表现的胸膜厚度、胸腔积液密度变化进行比较。结果恶性组胸腔积液CEA/血清CEA比值高于结核性组[6.72±6.9 vs 0.82±0.43（t=-3.832,P=0.001）,ADA水平低于结核性组（21.9±6.5）vs（50.3±31.9）U/L（t=4.474,P=0.000）];恶性组胸膜厚度〉10.0 mm且以弥漫型为主,结核性组胸膜厚度6.0 mm左右且以局限性为主;胸膜厚度、ADA、胸腔积液CEA/血清CEA3项联合检测的灵敏度、特异度、灵敏度/1-特异性（AUC）分别为90.0%、96.0%、0.869,均高于单检和2项联检,且3项联检的特异度与胸腔积液CEA/血清CEA＋ADA、胸膜厚度＋胸腔积液CEA/血清CEA联检的特异度比较差异均有统计学意义（均P〈0.05）。结论胸膜厚度、ADA、胸腔积液CEA/血清CEA3项联合检测对鉴别恶性与结核性胸腔积液有较高的临床价值。