FEV_1/FVC<0.7诊断慢性阻塞性肺疾病准确性Meta分析

目的采用Meta分析法评估1 s用力呼气量(FEV1)/用力肺活量(FVC)0.7(GOLD标准)诊断慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)的可靠性。方法以FEV1/FVC和(或)1 s用力呼气量/用力肺活量、FEV1和(或)1 s用力呼气量、LLN和(或)正常值下限为检索词,检索MEDLINE、EMBASE和Cochrane图书馆数据库1966年1月—2012年9月收录的关于GOLD标准和正常值下限(LLN)标准诊断COPD的中英文文献,对符合相关纳入和排除标准的文献采用RevMan 5.1和Meta-DiSc软件行Meta分析。结果本次检索共命中1877篇文献,其中纳入6篇,共47 092例患者。纳入文献采用GOLD标准诊断COPD的森林图显示:灵敏度0.9095%可信区间(CI):0.89,0.90],特异度0.92(95%CI:0.91,0.92),阳性似然比14.55(95%CI:9.22,22.97),阴性似然比0.06(95%CI:0.03,0.15),诊断比值比259.12(95%CI:150.76,445.37)。汇总受试者工作特征曲线,曲线下面积为0.9827,Q值为0.9424。对其中两篇描述年龄对GOLD标准诊断气流受限的文献行Meta分析,结果显示随着年龄的增长,特异度、阳性似然比及诊断比值比进行性下降。结论总体来说,FEV1/FVC0.7作为COPD的诊断标准具有较高的可靠性,但老年人随着年龄的增长,误诊率进行性升高。

The Fixed-Value of FEV1/FVC <0. 7 in Diagnosis of Chronic Obstructive Pulmonary Disease:A Diagnostic Meta-analysis

Objective To assess the reliability of fixed-value of FEV1/FVC 〈0. 7 （GOLD standard） in diagnosis of chronic obstructive pulmonary disease （ COPD） by meta-analysis. Methods By using FEV1/ FVC, FEV1 and LLN as retrieving words, MEDLINE, EMBASE and Cochrane libraries were searched for studies comparing FEV1/FVC〈LLN and GOLD standard for COPD diagnosis between January 1966 and September 2012. By using RevMan 5. 1 and Meta-DiSc software, the meta-analysis was performed for the included articles which met the inclusion and exclusion criteria. Results Of 1877 identified studies, 6 studies and 47 092 cases were included. For GOLD standard, sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0. 90 （95%CI：0. 89-0. 90）, 0. 92 （95%CI：0. 91-0. 92）, 14. 55 （95%CI：9. 22-22. 97）, 0. 06 （95%CI：0. 03-0. 15）, and 259. 12 （95%CI：150. 76-445. 37）, respectively. Good summary receiver operator characteristic with an area under the curve of 0. 9827 and a Q point of 0. 9424 were observed. Two studies about the impact of age with GOLD standard in the diagnosis of airflow limitation were made meta-analysis, and the results showed that diagnosis parameters decreased with age, such as specificity, positive likelihood ratio and diagnostic odds ratio. Conclusion The value of FEV1/FVC 〈0. 7 remains useful preliminary diagnostic assessment for COPD with high reliability in most populations, but it may lead to increasing misdiagnosis rate with age in elder patients.