抗心肌抗体对中国扩张型心肌病诊断价值的Meta分析

谷晓莹; 余淼; 廖玉华; 袁璟

doi:10.13201/j.issn.1001-1439.2016.10.015

抗心肌抗体对中国扩张型心肌病诊断价值的Meta分析

- 华中科技大学附属协和医院心内科华中科技大学同济医学院心血管病研究所(武汉, 430022)
基金项目:
国家“十二五”科技支撑计划(No:2011BAI11B23)

国家自然科学基金面上项目(No:81470502)

详细信息

通讯作者: 袁璟,E-mail:yhelen13@163.com

中图分类号: R542.2

收稿日期: 2016-07-06

Diagnostic value of anti-heart autoantibodies in Chinese patients with dilated cardiomyopathy:A Meta-analysis

- Institute of Cardiology, Union Hospital, Huazhong University of Science and Technology, Wuhan, 430022, China

More Information

Corresponding author: YUAN Jing, E-mail: yhelen13@163.com

Received Date: 06 July 2016

摘要

摘要: 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。
- 抗心肌抗体 /
- 扩张型心肌病 /
- 诊断性试验 /
- Meta分析 /
- 中国人
Abstract: Objective:To systematically review the diagnostic value of anti-hear tautoantibodies(AHA)in Chinese patients with dilated cardiomyopathy(DCM).Method:The data bases including PubMed,the Cochrane Library,EMbase,CNKI,CBM,VIP and Wanfang Data from inception to February 2016 were searched for serum AHA detection in Chinese DCM patients.Literature screening about the inclusion and exclusion criteria,data extraction and methodological quality assessment were completed by two reviewers independently.Then,meta-analysis was performed using Meta-Disc 1.4software.The subgroup analysis was stratified by different types and detection methods of AHA.Finally,funnel plots were drawn using Stata 12.0software to assess potential publication bias.Result:Twenty-three documents and a total of 37 studies were included.The Meta-analysis results showed that,the pooled sensitivity(Sen)and specificity(Spe)of AHA in DCM were 0.69(95%CI 0.67to0.71,P=0.0000)and 0.88(95%CI0.87 to 0.89,P=0.0000)respectively.The positive likelihood ratio(+LR)was 7.44(95%CI5.63 to 9.82,P=0.0000),while the negative likelihood ratio(-LR)was 0.39(95%CI0.32 to 0.47,P=0.0000).The diagnostic odds ratio(DOR),overall area under the curve(AUC),and Q*were 26.74(95%CI18.02 to 39.68,P=0.0000),0.9232(SE=0.012 6),and 0.857 1(SE=0.014 7)seperately.Furthermore,the subgroup studies indicated that the sensitivities of different AHA were autoantibodies against calcium channel(AAb-CC,0.77)> myosin(AAb-MHC,0.72)> ADP/ATP carrier(AAb-ANT,0.71)> β-1adrenergic receptor(AAb-β1R,0.68)> M2-muscarinic receptor(AAb-M2 R,0.47),and the specificities were AAb-ANT(0.94)> AAb-M2R(0.92)> AAb-MHC(0.89)> AAb-β1R(0.86)> AAb-CC(0.75).For detection of AHA,the method of ELISA was largely used and better than Western blotting,which was especially proved in AAb-ANT investigation from DCM patients(Z=0.92,P=0.042).Conclusion:AHA has relatively high Sen and Spe in the diagnosis of DCM,and ELISA is a suitable method for AHA detection.
- anti-heart autoantibodies /
- dilated cardiomyopathy /
- diagnostic test /
- meta-analysis /
- Chinese

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