尿液羧肽酶B激活肽作为急性重症胰腺炎早期诊断的潜在标志物:一项具有试验序贯分析的Meta分析

目的探讨尿液羧肽酶B激活肽(carboxypeptidase B activating peptide, CAPAP)作为急性重症胰腺炎(severe acute pancreatitis, SAP)早期标志物的诊断价值。方法检索PubMed、Embase、Web of Science、中国知网、万方以及维普数据库,时间为1995年1月至2021年3月。RevMan5.3制作QUADAS-2量表评估文献质量,Stata 16.0软件荟萃分析及绘制综合受试者工作特征(summary receiver operating characteristic,SROC)曲线,TSA 0.9.5.10 Beta软件试验序贯分析。结果纳入9项研究,研究无阈值效应,CAPAP诊断SAP的灵敏度、特异度、阳性似然比(postive likelihood ratio, PLR)、阴性似然比(negative likelihood ratio, NLR)、诊断比值比(diagnostic oddsratio, DOR)分别为0.84、0.92、10、0.17、59;SROC曲线下面积为0.94;亚组分析提示,发表年份、研究区域和检测方法不是异质性来源;发表偏倚及敏感性分析提示文献存在发表偏倚;试验序贯分析提示需纳入更大的样本量验证CAPAP对SAP的诊断效能。结论尿液CAPAP可以作为SAP诊断困难时的辅助指标,仍需多中心、大样本、前瞻性的研究予以验证。

Urinary carboxypeptidase B activating peptide as a potential marker for early diagnosis of severe acute pancreatitis: a Meta-analysis with experimental sequential analysis

Objective To explore the diagnostic value of urinary carboxypeptidase B activating peptide(CAPAP) as an early marker of severe acute pancreatitis(SAP).Methods PubMed, Embase, Web of Science, CNKI, WanFang and VIP databases were searched from Jan. 1995 to Mar. 2021. RevMan5.3 was used to draw QUADAS-2 scale to evaluate the quality of literature;Stata 16.0 was used to conduct Meta-analysis and draw summary receiver operating characteristic(SROC) curve;TSA 0.9.5.10 Beta software test was used to sequential analysis. Results 9 studies were included. The sensitivity, specificity, positive likelihood ratio(PLR), negative likelihood ratio(NLR) and diagnostic odds ratio(DOR) of CAPAP in the diagnosis of SAP were 0.84, 0.92, 10, 0.17 and 59, respectively;the area under the SROC curve was 0.94;subgroup analysis showed that publication year, research area and detection method were not the sources of heterogeneity;publication bias and sensitivity analysis showed that there was publication bias in the literature;sequential analysis suggested that a larger sample size should be included to verify the diagnostic efficacy of CAPAP for SAP.Conclusion Urinary CAPAP can be used as an auxiliary index in the diagnosis of SAP, which still needs to be verified by multi-center, large sample and prospective study.