糖缺失性转铁蛋白诊断酒精性肝病准确性的评价

目的对国内外发表的糖缺失性转铁蛋白(CDT)或其相对值(%CDT)诊断酒精性肝病(ALD)的研究进行系统评价,为酒精性肝病的临床诊断提供参考依据。方法计算机检索PubMed、EMBASE、维普、万方、中国期刊全文数据库等文献数据库。按照纳入和排除标准对所检索的文献进行筛选并提取研究中相关的数据,采用MetaDiSc1.4软件对研究进行评价,对诊断的准确性进行Meta分析。结果符合纳入标准的研究共6篇,其中ALD组259例,非酒精性肝病组(NALD)组308例,健康人群组262例。Meta分析结果显示:ALD与NALD组鉴别诊断中,其合并敏感度(Se)、特异度(Sp)、阳性似然比(+LR)、阴性似然比(-LR)、诊断优势比(DOR)和汇总受试者工作特征曲线(SROC)曲线下面积分别为:72%、82%、4.20、0.34、15.46、0.866 7;ALD与健康对照组鉴别中,其合并Se、Sp、+LR、-LR、DOR和SROC曲线下面分别为:73%、89%、5.62、0.35、27.76、0.908 5。结论临床应用CDT或%CDT对ALD进行排除诊断时准确性性较高,但运用在ALD的诊断中需要结合患者的饮酒史进行综合评价。上述研究结果还需要更多设计科学、严谨的临床试验验证。

A systematic assessment of the diagnostic accuracy of carbohydrate deficient transferrin in alcoholic liver disease

Objective To systematically assess the performance of carbohydrate deficient transferrin（CDT）or its relative value（%CDT）in the diagnosis of alcoholic liver disease（ALD）.Methods Databases,including PubMed,EMBASE,CNKI,WanFang and CSJD,were retrieved for related articles about the application fo CDT in the diagnosis for ALD.MetaDisc1.4software was used to assess accuracy of it.Results Six studies met the eligibility criteria and were included,including 259cases for ALD group,308cases for NALD group and 262cases for normal group.Meta analysis indicated that,for the differential diagnosis between ALD group and NALD group,the summary values of sensitivity（Se）,specificity（Sp）,positive likelihood ratio（＋LR）,negative likelihood ratio（-LR）,diagnostic odds ratio（DOR）and area under summary receiver operating curve（SROC AUC）were 72%,82%,4.20,0.34,15.46and 0.866 7,and for the differential diagnosis between ALD group and normal group,the summary values of Se,Sp,＋LR,-LR,DOR and SROC AUC were 73%,89%,5.62,0.35,27.76and 0.908 5.Conclusion CDT or%CDT might be accurate for the exclusive diagnosis of ALD,but should be combined with drinking history for the diagnosis of ALD.The results might need to be studied further in future.