比浊法检测血清IgG4对自身免疫性胰腺炎诊断的Meta分析

doi:10.3969/j.issn.1673-8640.2015.11.017

摘要/Abstract

摘要： 目的

采用Meta分析的方法探讨比浊法检测血清IgG4对自身免疫性胰腺炎(AIP)的诊断价值。

方法

检索万方、中国知网、中国生物医学文献服务系统、PubMed、Embase、Web of Science、Sciencedirect、Cochrane等数据库,从建库到2014年9月22日关于比浊法检测血清IgG4对AIP诊断的相关中英文文献,对文献所列参考文献进行手工检索。严格按照纳入和排除标准进行文献筛选,采用质量评价工具(QUADAS)进行质量评价。采用Meta-disc 1.4软件对最终纳入的文献进行合并敏感性、合并特异性、合并诊断比值比(DOR)分析并绘制综合受试者工作特征 (SROC)曲线,采用Stata12.0软件进行发表偏倚评价。

结果

共12篇文献纳入研究,其中8篇文献可以提取出AIP与胰腺癌鉴别诊断的四格表数据。异质性检验提示没有阈值效应,但存在其他因素引起的异质性。分析显示,比浊法检测血清IgG4对于区分AIP和所有对照组的合并敏感性、合并特异性分别为73%和94%,对于区分AIP和胰腺癌的合并敏感性和合并特异性分别为70%和92%。Deeks漏斗图显示不存在发表偏倚,敏感性分析结果稳定。

结论

比浊法检测血清IgG4对于AIP临床诊断价值较高,且用其鉴别诊断AIP和胰腺癌也有较高的价值。

关键词: IgG4, Meta分析, 自身免疫性胰腺炎, 胰腺癌

Abstract: Objective

Meta analysis was used to evaluate the diagnostic significance of serum IgG4 by nephelometry for autoimmune pancreatitis (AIP).

Methods

By searching Wanfang, CNKI and SinoMed, PubMed, Embase, Web of Science, Scienecdirect, Cochrane from inception to September 22, 2014, combined with additional manual tracking, both English and Chinese literatures about serum IgG4 by nephelometry for the diagnosis of AIP were reviewed. According to the inclusion and exclusion criteria, literatures were selected. Quality assessment was conducted according to Quality Assessment of Diagnostic Accuracy Studies (QUADAS). Sensitivity, specificity and diagnostic odds ratio (DOR) were pooled, and summary receiver operating characteristic (SROC) curve was drawn by the software Meta-disc 1.4. Publication bias was analyzed by Stata12.0 software.

Results

A total of 12 studies were included. Diagnostic two-by-two table about differentially diagnosing AIP and pancreatic cancer were constructed from 8 studies of the 12 studies. Test for heterogeneity suggested no threshold effect, but there was significant heterogeneity caused by other factors group. The pooled sensitivity and specificity were 73% and 94% for AIP with control group. The pooled sensitivity and specificity were 70% and 92% for AIP with pancreatic cancer. Funnel plots (Deeks) revealed no publication bias, and sensitivity analysis revealed that the results of this meta analysis were stable.

Conclusions

Serum IgG4 by nephelometry is a useful parameter in diagnosing AIP as well as differentiating AIP from pancreatic cancer.

Key words: IgG4, Meta analysis, Autoimmune pancreatitis, Pancreatic cancer

中图分类号:

R446.62

练明建, 刘丹, 李丹, 刘树业. 比浊法检测血清IgG4对自身免疫性胰腺炎诊断的Meta分析[J]. 检验医学, 2015, 30(11): 1131-1137.

LIAN Mingjian, LIU Dan, LI Dan, LIU Shuye. Meta analysis on serum IgG4 in the diagnosis of autoimmune pancreatitis by nephelometry[J]. Laboratory Medicine, 2015, 30(11): 1131-1137.

图/表 4

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作者	年份	区域	临界值 (mg/dL)	诊断标准	AIP	区分AIP与对照组				评分	区分AIP与胰腺癌
作者	年份	区域	临界值 (mg/dL)	诊断标准	AIP	TP		FP	FN	TN	TP	FP	FN	TN
GHAZALE等^[8]	2007	美国	140	HISORt	45	34	33	11	432	15	34	13	11	122
HIRANO等^[9]	2006	日本	135	JPS 2002或长时间观察	35	33	4	2	77	17	33	0	2	23
APARISI等^[10]	2005	西班牙	130	Spanish score	6	4	8	2	169	15	—	—	—	—
UEHARA等^[11]	2005	日本	135	临床经验	6	6	0	0	6	12	—	—	—	—
SONG等^[12]	2009	韩国	135	Asian或 HISORt	82	43	1	39	109	13	43	1	39	109
VAN HEERDE等^[13]	2014	荷兰	140	ICDC, Asian 或 HISORt等	33	28	10	5	43	13	28	10	5	43
SADLER等^[14]	2011	英国	130	HISORt	21	19	15	2	160	15	—	—	—	—
TABATA等^[15]	2009	日本	135	Asian	39	30	45	9	384	15	30	5	9	111
KAJI等^[16]	2011	日本	135	Asian或ICDC	35	32	2	3	69	15	—	—	—	—
鲁琼等^[17]	2011	中国	200	Asian	11	11	17	0	752	15	11	0	0	30
CHANG等^[18]	2014	中国台湾	140	HISORt, Asian或ICDC	188	105	22	57	154	15	105	18	57	72
VAN TOOREN-ENBERGEN等^[19]	2010	荷兰	160	HISORt	13	9	1	4	11	13	9	1	4	11

作者	年份	区域	临界值 (mg/dL)	诊断标准	AIP	区分AIP与对照组				评分	区分AIP与胰腺癌
作者	年份	区域	临界值 (mg/dL)	诊断标准	AIP	TP		FP	FN	TN	TP	FP	FN	TN
GHAZALE等^[8]	2007	美国	140	HISORt	45	34	33	11	432	15	34	13	11	122
HIRANO等^[9]	2006	日本	135	JPS 2002或长时间观察	35	33	4	2	77	17	33	0	2	23
APARISI等^[10]	2005	西班牙	130	Spanish score	6	4	8	2	169	15	—	—	—	—
UEHARA等^[11]	2005	日本	135	临床经验	6	6	0	0	6	12	—	—	—	—
SONG等^[12]	2009	韩国	135	Asian或 HISORt	82	43	1	39	109	13	43	1	39	109
VAN HEERDE等^[13]	2014	荷兰	140	ICDC, Asian 或 HISORt等	33	28	10	5	43	13	28	10	5	43
SADLER等^[14]	2011	英国	130	HISORt	21	19	15	2	160	15	—	—	—	—
TABATA等^[15]	2009	日本	135	Asian	39	30	45	9	384	15	30	5	9	111
KAJI等^[16]	2011	日本	135	Asian或ICDC	35	32	2	3	69	15	—	—	—	—
鲁琼等^[17]	2011	中国	200	Asian	11	11	17	0	752	15	11	0	0	30
CHANG等^[18]	2014	中国台湾	140	HISORt, Asian或ICDC	188	105	22	57	154	15	105	18	57	72
VAN TOOREN-ENBERGEN等^[19]	2010	荷兰	160	HISORt	13	9	1	4	11	13	9	1	4	11

组别	篇数	合并敏感性[95%CI,I²(%)]	合并特异性[95%CI,I²(%)]	DOR[95%CI,I²(%)]	AUC
区分AIP与对照组	12	0.73(0.68~0.76,80.70)	0.94(0.93~0.95,84.80)	58.34(29.00~117.33,68.30)	0.949
区分AIP与胰腺癌	8	0.70(0.65~0.74,82.30)	0.92(0.89~0.94,83.60)	43.42(15.98~117.96,75.50)	0.894
区域
亚洲	7	0.70(0.65~0.75,87.70)	0.94(0.93~0.96,89.70)	98.17(28.49~338.25,81.00)	0.969
非亚洲	5	0.80(0.71~0.87,4.20)	0.92(0.90~0.94,60.70)	38.95(22.61~67.08,0.00)	0.926
研究年份
2010年以前	6	0.70(0.64~0.76,83.40)	0.93(0.91~0.94,75.10)	55.20(26.88~113.35,37.10)	0.948
2010年及以后	6	0.74(0.69~0.79,80.90)	0.95(0.93~0.96,89.70)	61.99(17.49~219.72,78.40)	0.955
AIP研究例数
>20例	8	0.72(0.67~0.76,84.70)	0.92 (0.90~0.93,77.00)	53.14(24.35~115.97,75.20)	0.941
≤20例	4	0.83(0.67~0.94,65.70)	0.97(0.96~0.98,22.70)	78.62(22.60~273.67,33.10)	0.989
疾病谱
疾病谱全	7	0.76(0.71~0.80,82.00)	0.94(0.93~0.95,88.50)	73.08(27.59~193.53,81.20)	0.983
疾病谱不全	5	0.64(0.56~0.72,76.80)	0.94(0.92~0.97,79.40)	46.75(20.50~106.61,0.00)	0.906

组别	篇数	合并敏感性[95%CI,I²(%)]	合并特异性[95%CI,I²(%)]	DOR[95%CI,I²(%)]	AUC
区分AIP与对照组	12	0.73(0.68~0.76,80.70)	0.94(0.93~0.95,84.80)	58.34(29.00~117.33,68.30)	0.949
区分AIP与胰腺癌	8	0.70(0.65~0.74,82.30)	0.92(0.89~0.94,83.60)	43.42(15.98~117.96,75.50)	0.894
区域
亚洲	7	0.70(0.65~0.75,87.70)	0.94(0.93~0.96,89.70)	98.17(28.49~338.25,81.00)	0.969
非亚洲	5	0.80(0.71~0.87,4.20)	0.92(0.90~0.94,60.70)	38.95(22.61~67.08,0.00)	0.926
研究年份
2010年以前	6	0.70(0.64~0.76,83.40)	0.93(0.91~0.94,75.10)	55.20(26.88~113.35,37.10)	0.948
2010年及以后	6	0.74(0.69~0.79,80.90)	0.95(0.93~0.96,89.70)	61.99(17.49~219.72,78.40)	0.955
AIP研究例数
>20例	8	0.72(0.67~0.76,84.70)	0.92 (0.90~0.93,77.00)	53.14(24.35~115.97,75.20)	0.941
≤20例	4	0.83(0.67~0.94,65.70)	0.97(0.96~0.98,22.70)	78.62(22.60~273.67,33.10)	0.989
疾病谱
疾病谱全	7	0.76(0.71~0.80,82.00)	0.94(0.93~0.95,88.50)	73.08(27.59~193.53,81.20)	0.983
疾病谱不全	5	0.64(0.56~0.72,76.80)	0.94(0.92~0.97,79.40)	46.75(20.50~106.61,0.00)	0.906