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目的:系统评价国内抗心肌抗体(AHA)对扩张型心肌病(DCM)的诊断价值。方法:计算机检索PubMed、The Cochrane Library、EMbase、CNKI、CBM、VIP、Wanfang Data数据库中有关国内AHA诊断DCM的诊断性试验,检索时限均为从建库至2016年2月25日。由2位研究者独立筛选文献、提取数据和评价纳入研究的方法学质量后,采用Meta-Disc1.4软件进行Meta分析,并按照AHA不同种类及不同检测方法进行亚组分析。最后采用Stata12.0软件绘制漏斗图和评估发表偏倚。结果:最终纳入23篇文献,共37个研究。AHA诊断DCM的Meta分析结果显示:Sen合并=0.69[95%CI(0.67,0.71),P=0.0000]、Spe合并=0.88[95%CI(0.87,0.89),P=0.0000]、+LR合并=7.44[95%CI(5.63,9.82),P=0.049 1]、-LR合并=0.39[95%CI(0.32,0.47),P=0.0000]和DOR合并=26.74[95%CI(18.02,39.68),P=0.0000]。SROC曲线下面积AUC为0.923 2(SE=0.012 6),Q*=0.857 1(SE=0.014 7)。亚组分析结果显示:15种不同AHA的灵敏度分别为抗Ca2+通道抗体(0.77)>抗MHC抗体(0.72)>抗ANT抗体(0.71)>抗β1-AR抗体(0.68)>抗M2R抗体(0.47),特异性分别为抗ANT抗体(0.94)>抗M2R抗体(0.92)>抗MHC抗体(0.89)>抗β1-AR抗体(0.86)>抗Ca2+通道抗体(0.75)。2酶联免疫吸附测定(ELISA)与免疫转印法检测抗ANT抗体对DCM诊断准确性的差异有统计学意义(Z=0.92,P=0.042),ELISA组的诊断效能高于免疫转印组。结论:AHA对DCM的早期诊断具有较高的灵敏度及特异性;ELISA法临床检测AHA适合在临床推广。
Objective: To systematically evaluate the diagnostic value of domestic anti-myocardial antibodies (AHA) in patients with dilated cardiomyopathy (DCM). METHODS: The computer-based diagnostic tests of AHA diagnosing DCM in PubMed, The Cochrane Library, EMbase, CNKI, CBM, VIP and Wanfang Data were searched by computer. The search time ranged from building database to February 25, 2016. After two independent researchers screened the literature, extracted data and evaluated the methodology quality of the included studies, Meta-Disc 1.4 software was used for meta-analysis and sub-analysis according to different types of AHA and different detection methods. Finally, the funnel plot was drawn with Stata12.0 software and the publication bias was evaluated. Results: The final inclusion of 23 articles, a total of 37 studies. Meta-analysis of AHA diagnosed DCM showed that Sen merge = 0.69 [95% CI (0.67,0.71), P = 0.0000], Spe merge = 0.88 [95% CI (0.87,0.89), P = 0.0000] = 7.44 [95% CI (5.63,9.82), P = 0.049 1], LR incorporation = 0.39 [95% CI (0.32,0.47), P = 0.0000] and DOR incorporation = 26.74 [95% CI ), P = 0.0000]. The area under the SROC curve, AUC, was 0.923 2 (SE = 0.012 6), Q * = 0.857 1 (SE = 0.014 7). Subgroup analysis showed that the sensitivity of 15 different AHA were anti-Ca2 + channel antibody (0.77)> anti-MHC antibody (0.72)> anti-ANT antibody (0.71)> anti-β1-AR antibody ) And anti-ANT antibody (0.94)> anti-M2R antibody (0.92)> anti-MHC antibody (0.89)> anti-β1-AR antibody (0.86)> anti-Ca2 + channel antibody (0.75). There was a significant difference between the two groups (Z = 0.92, P = 0.042). The diagnostic efficiency of ELISA group was higher than that of immuno-transfer group . Conclusion: AHA has high sensitivity and specificity for the early diagnosis of DCM. The clinical application of ELISA in the clinical diagnosis of AHA is suitable for clinical promotion.