呼出气一氧化氮对慢性咳嗽人群中咳嗽变异型哮喘的诊断价值:Meta分析

目的 咳嗽变异型哮喘(cough variant asthma,CVA)是慢性咳嗽的常见病因.本研究旨在应用Meta分析的方法评价呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)检测对慢性咳嗽人群CVA诊断的有效性和准确性.方法 检索Embase、PubMed、Medline、Cochrane library、Web of science、百度学术、中国期刊网和万方数据库,全面收集FeNO在慢性咳嗽人群对CVA诊断的文献,检索时限均从建库至2016年8月.根据QUADAS-2量表的评价标准对文献进行质量评价.用Stata 14.0、RevMan 5.0软件对文献进行异质性分析,并计算合并的敏感性、特异性、阳性似然比、阴性似然比、诊断优势比和SROC曲线下面积.结果 共纳入文献5篇,涉及慢性咳嗽患者704例.FeNO检测诊断CVA合并的敏感度、特异度、阳性似然比、阴性似然比、诊断优势比、SROC曲线下面积分别为0.74 95％可信区间(CI):0.69～0.79],0.85 (95％ CI:0.81～0.88),4.73 (95％CI:3.70～6.05),0.31 (95％ CI:0.26～0.38),14.84 (95％CI:10.11～21.79)和0.87 (95％CI:0.84～0.89).结论 FeNO对慢性咳嗽人群中CVA的诊断有较好的敏感度和特异度,可作为重要的诊断指标.

Diagnostic accuracy of fractional exhaled nitric oxide for cough variant asthma in chronic cough patients:a meta-analysis

Objective Cough variant asthma (CVA) is a common cause of chronic cough.This study is to evaluate the effectiveness and accuracy of fractional exhaled nitric oxide (FeNO) for diagnosing CVA among patients with chronic cough.Methods We searched the Embase,PubMed,Medline,Cochrane library,Web of science,Baidu scholar,Chinese National Knowledge Infrastructure (CNKI,in Chinese),and Wanfang (in Chinese) databases for articles published from inception to August 2016.Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) items were used for quality assessment of included studies.The Stata 14.0 and RevMan 5.0 softwares were adopted to perform the heterogeneity test and pooled the sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio,and the area under curve (AUC) of summary receiver operating characteristics (SROC) curve.Results There were 5 eligible studies,which included 704 participants in this meta-analysis.It was showed that the pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio,and the AUC of SROC curve were 0.74 95 ％ confidence interval (CI):0.69-0.79],0.85 (95 ％ CI:0.81-0.88),4.73 (95％ CI:3.70-6.05),0.31 (95％ CI:0.26-0.38),14.84 (95％ CI:10.11-21.79) and 0.87 (95％ CI:0.84-0.89),respectively for CVA.Conclusions This meta-analysis suggests that FeNO has better sensitivity and specificity,and could be used as an important index of diagnosing CVA among patients with chronic cough.