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目的系统评价抗角蛋白抗体(AKA)诊断类风湿性关节炎(RA)的准确性。方法计算机检索PubMed(1966～2010.6)、Cochrane图书馆(2010年第6期)、中国生物医学文献数据库(1978～2010.6)、中国期刊全文数据库(1994～2010.6)、中文科技期刊全文数据库(1989～2010.6)、中华医学会数字化期刊库(1997～2010.6)等,收集用AKA诊断RA的试验研究,依据QUADAS质量评价标准评价纳入研究的质量后,采用Meta-Disc软件(version 1.4)进行Meta分析。结果共纳入69个研究,合计14?890例受试者。Meta分析结果显示:与美国风湿病协会修订的RA分类标准相比,AKA诊断RA的合并敏感度、特异度、阳性似然比、阴性似然比、诊断比值比和SROC曲线下面积分别为0.41(0.39,0.42)、0.94(0.94,0.95)、9.52(7.21,12.57)、0.63(0.60,0.66)、15.24(11.62,19.98)和0.613?6。结论 AKA可以作为确诊RA的方法之一,并建议临床医生使用时,与其它的自身抗体检测方法联用。
Objective To evaluate the accuracy of anti-keratin antibodies (AKA) in the diagnosis of rheumatoid arthritis (RA). Methods We searched PubMed (1966 ~ 2010.6), Cochrane Library (2010), China Biomedical Literature Database (1978-2010.6), Chinese Journal Full-text Database (1994-2010.6), Chinese Science and Technology Journals Full-text Database 2010.6) and the Chinese Medical Association Digital Periodical Library (1997-2010.6). We collected experimental studies on the diagnosis of RA with AKA. Meta-analysis was performed using Meta-Disc software (version 1.4) after the quality of the studies was evaluated according to QUADAS quality evaluation criteria. Results A total of 69 studies were included, totaling 14,890 participants. The results of Meta analysis showed that the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and area under the curve of SROC were 0.41 for AKA diagnosis of RA compared with the RA classification revised by American Rheumatism Association (0.39, 0.42), 0.94 (0.94, 0.95), 9.52 (7.21, 12.57), 0.63 (0.60, 0.66), 15.24 (11.62, 19.98) and 0.613-6. Conclusions AKA can be used as one of the methods to diagnose RA. It is recommended that clinicians use other autoantibodies in combination with other autoantibodies.