ELISA法检测血清抗核小体抗体诊断系统性红斑狼疮价值的系统评价

目的评价ELISA法检测血清中抗核小体抗体(anti-nucleosome antibody,AnuA)诊断系统性红斑狼疮(systemic lupus erythematosus,SLE)的价值。方法检索MEDLINE、EMbase、Cochrane图书馆等数据库,检索时间为1990～2005年,收集关于AnuA诊断SLE价值的相关研究文献,进行质量评价,利用Cochrane协作网提供的RevMan软件进行异质性分析,MetaDisc进行Meta分析及绘制SROC曲线。结果共纳入文献25篇,合计7289例,其中经金标准确认的SLE患者2459例,非SLE者5030例。Meta分析结果显示,各纳入研究均存在不同程度的质量问题,导致各研究间存在高度异质性(P<0.00001,I2=87.2%),合并敏感度为64.9%,95%CI63.0%～66.8%,合并特异度为92.6%,95%CI91.8%～93.3%;SROC曲线下面积0.918,SE0.0212。结果表明其平均漏诊率较高(35.1%),平均误诊率较低(7.4%),有一定的诊断价值。结论目前ELISA法检测抗核小体抗体诊断SLE具有一定诊断价值,可作为诊断SLE的诊断指标。

Diagnostic Value of Anti-nucleosome Antibody in SLE Patients: A Systematic Review

Objective To evaluate the diagnostic value of anti-nucleosome antibody(AnuA)in patients with systemic lupus erythematosus(SLE).Methods We searched MEDLINE,EMbase and The Cochrane Library to identify studies on the diagnostic value of AnuA in patients with SLE.The searching time was from 1990 to 2005.The quality of included studies was evaluated and the data were extracted.The Cochrane Collaboration's RevMan software was used to analyze heterogeneity,and MetaDisc was used to perform meta-analyses and draw summary receiver operator characteristic curve(SROC).Results Twenty-five studies involving 7 289patients(2 459 SLE and 5 030 non-SLE patients were diagnosed by gold standard)were included,most of which were poor in quality.The heterogeneity among studies was high(P<0.000 01,I2=87.2%).The pooled sensitivity was 64.9%,95% CI 63.0 to 66.85,and the pooled specificity was 92.6%,95% CI 91.8% to 93.3%.Area under the SROC was 0.918,SE0.0212.These data suggested that AnuA had a relatively high false negative rate(35.1%)and a relatively low false positive rate(7.4%).Conclusions AnuA has some value in diagnosing SLE and could possibly be used as one of the diagnostic tests for SLE.