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目的系统评价血清抗C1q抗体在中国人群狼疮肾炎(lupus nephritis,LN)诊断中的价值。方法计算机检索PubMed、EMbase、CNKI、The Cochrane Library、VIP和WanFang Data数据库,搜集血清中抗C1q抗体在中国人群中诊断LN的相关诊断性试验,检索时限均为建库至2015年3月1日。由2位评价员独立筛选文献、提取资料,并采用QUADAS工具评价纳入研究的方法学质量后,采用Meta-Disc 1.4软件及Stata 11.0软件进行Meta分析。结果最终纳入11个研究,共1 084例系统性红斑狼疮(systemic lupus erythematosus,SLE)患者,其中LN患者474例。Meta分析结果显示,抗C1q抗体诊断LN的合并敏感度、特异度、诊断比值比、阳性似然比和阴性似然比分别为0.67[95%CI(0.63,0.71)]、0.69[95%CI(0.65,0.74)]、5.09[95%CI(3.29,7.85)]、2.18[95%C(I 1.75,2.72)]和0.48[95%CI(0.39,0.60)],SROC曲线下面积(AUC)为0.749 6,Q*=0.693 1。抗C1q抗体诊断LN的平均漏诊率和平均误诊率分别为33.0%和31.0%。结论抗C1q抗体在诊断LN中具有一定诊断价值,但因存在较高的漏诊率和误诊率,尚不能单独用于LN的诊断,可作为LN的辅助诊断指标。受纳入研究数量和质量所限,上述结论尚需开展更多高质量研究予以验证。
Objective To evaluate the value of serum anti-C1q antibody in the diagnosis of lupus nephritis (LN) in Chinese population. Methods The databases of PubMed, EMbase, CNKI, The Cochrane Library, VIP and WanFang Data were searched by computer to collect the relevant diagnostic tests of serum anti-C1q antibody for the diagnosis of LN in Chinese population. The search time was from the database to March 1, 2015 . The two reviewers independently screened the literature, extracted the data, and evaluated the quality of the included studies using the QUADAS tool. Meta-analysis was performed using Meta-Disc 1.4 software and Stata 11.0 software. Results A total of 1 084 patients with systemic lupus erythematosus (SLE) were enrolled in 11 studies, including 474 LN patients. Meta-analysis showed that the combined sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio and negative likelihood ratio of anti-C1q antibody in diagnosis of LN were 0.67 [95% CI (0.63,0.71)], 0.69 [95% CI (AUC (0.65,0.74)], 5.09 [95% CI 3.29,7.85], 2.18 [95% CI 1.75,2.72] and 0.48 95% CI 0.39,0.60] ) Is 0.749 6, Q * = 0.693 1. The mean misdiagnosis rate and average misdiagnosis rate of anti-C1q antibody in diagnosis of LN were 33.0% and 31.0% respectively. Conclusion Anti-C1q antibody has some diagnostic value in the diagnosis of LN. However, it has not yet been used alone for the diagnosis of LN because of its high rate of misdiagnosis and missed diagnosis, which can be used as an auxiliary diagnostic indicator of LN. Due to the limited number and quality of studies involved, the above conclusion still needs to be verified by more high-quality studies.