尿素呼气试验和粪便抗原检测对消化性溃疡出血患者幽门螺杆菌感染诊断价值的Meta分析

背景在消化性溃疡出血（PUB）患者中，抑酸药物的使用以及出血状态等会对幽门螺杆菌（H.pylori）感染的诊断造成干扰，关于尿素呼气试验（UBT）和粪便抗原检测（SAT）应用于出血患者的诊断准确性报道并不一致。目的明确UBT和SAT用于PUB患者H.pylori感染的准确性。方法计算机检索PubMed、EMBase、the Cochrane Library、Web of Science、中国知网、万方数据知识服务平台、中国生物医学文献服务系统（CBM），收集有关PUB患者运用UBT和/或SAT诊断H.pylori感染的诊断准确性试验，检索时间为建库至2021-03-31。提取资料并应用QUADAS-2工具进行文献质量评价；运用双变量混合效应模型和网络Meta分析模型（NMA）合并诊断试验效应量；采用Meta回归和亚组分析的方法探究异质性的来源。结果共纳入18篇文献，总计25项研究，包含1 105例患者。Meta分析结果显示，UBT、SAT诊断PUB患者H.pylori感染的合并灵敏度为0.90〔95%CI（0.79，0.95）〕、0.89〔95%CI（0.81，0.94）〕，合并特异度为0.91〔95%CI（0.86，0.95）〕、0.75〔95%CI（0.59，0.87）〕，合并诊断比值比为88.89〔95%CI（31.01，254.82）〕、24.35〔95%CI（13.76，43.09）〕，合并阳性似然比为10.07〔95%CI（6.07，16.71）〕、3.60〔95%CI（2.11，6.12）〕，合并阴性似然比为0.11〔95%CI（0.05，0.24）〕、0.15〔95%CI（0.09，0.24）〕，综合受试者工作特征（SROC）曲线下面积为0.93〔95%CI（0.90，0.95）〕、0.91〔95%CI（0.88，0.93）〕。Meta回归提示，取样时间对UBT和SAT的灵敏度异质性存在影响，取样时间和H.pylori感染判定标准对UBT的合并特异度异质性存在影响。Deek漏斗图提示纳入研究间不存在潜在发表偏倚（PUBT=0.53，PSAT=0.64）。结论UBT具有更好地发现PUB患者H.pylori感染的能力，对疾病诊断的帮助优于SAT。鉴于SAT的假阳性结果，针对PUB患者不推荐单独使用SAT，同时依据取样时间与诊断效能的负相关性，为尽量避免质子泵抑制剂对检测结果的影响，推荐血流动力学稳定条件下尽早完善H.pylori相关检测。

Urease Breath Test and Stool Antigen Test Diagnose Helicobacter Pylori Infection in Patients with Bleeding Peptic Ulcer:a Meta-analysis

Background In patients with peptic ulcer bleeding(PUB),intragastric blood and unavoidable medicine,including acid suppressive agent are suspected as limitary factors to diagnose Helicobacter pylori(H.pylori)infection correctly.The research conclusions about the accuracy of urease breath test(UBT)and stool antigen test(SAT)in patients with PUB are inconsistent.Objective To clarify the accuracy of UBT and SAT for H.pylori infection in PUB patients.Methods PubMed,EMBase,the Cochrane Library,Web of Science,CNKI,Wanfang Data Knowledge Service Platform,China Biomedical Literature Database(CBM)were retrieved by computer for relevant articles related to the diagnosis of H.pylori infection by UBT and/or SAT published from the establishment of the database to March 31,2021.The QUADAS-2 tool was used to evaluate the quality of the extracted literature.The bivariate mixed-effects regression model and network meta-analysis model(NMA)were used to synthesize diagnostic test data.Meta-regression and subgroup analysis were performed to explore the sources of heterogeneity.Results A total of 18 articles were included,with a total of 25 studies and 1105 patients.Meta-analysis results showed that the combined sensitivity of UBT and SAT for diagnosing H.pylori infection in PUB patients were 0.90[95%CI(0.79,0.95)]and 0.89[95%CI(0.81,0.94)],the combined specificity were 0.91[95%CI(0.86,0.95)]and 0.75[95%CI(0.59,0.87)],the combined diagnostic odds ratio were 88.89[95%CI(31.01,254.82)]and 24.35[95%CI(13.76,43.09)],the combined positive likelihood ratio were 10.07[95%CI(6.07,16.71)]and 3.60[95%CI(2.11,6.12)],the combined negative likelihood ratio were 0.11[95%CI(0.05,0.24)]and 0.15[95%CI(0.09,0.24)],the area under the SROC curve were 0.93[95%CI(0.90,0.95)]and 0.91[95%CI(0.88,0.93)].Meta regression showed that the sampling time had an impact on the sensitivity heterogeneity of UBT and SAT,and the sampling time and the H.pylori infection criterion had an impact on the combined specificity heterogeneity of UBT.The Deek funnel chart indicated that there was no potential publication bias among the included researches(P_UBT=0.53,P_SAT=0.64).Conclusion In patients with PUB,UBT had a promising performance for the diagnosis of H.pylori infection.Because of the high number of false-positive results,SAT was not recommended for use in patients with PUB alone.At the same time,in order to avoid the impact of PPI on the detection results,it was recommended to perform the diagnostic tests as soon as possible under the condition of stable hemodynamics.