肌钙蛋白联合和肽素对急性心肌梗死早期诊断价值的荟萃分析

摘要

Objective To evaluate the value of the combination of troponin and copeptin in the early diagnosis of acute myocardial infarction(AMI) by a meta-analysis.Methods The studies about the application of the combination of troponin and copeptin in the early diagnosis of AMI were searched from Pubmed,CNKI,Wan Fang and VIP databases during their inception and May 2016,and were analyzed by the Meta-DiSc 1.4 software.Results A total of 19 relevant studies were enrolled,including 11 176 patients.95％ CI was calculated with the random effect model.The sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio(DOR) and the area under curve(AUCROC) of troponin alone and the combination of troponin and copeptin in the early diagnosis of AMI were 77％ (75％-79％) and 92％ (91％-93％),0.85 (0.85-0.86) and 0.60 (0.59-0.61),5.78 (4.01-8.32) and 2.25 (1.98-2.55),0.22(0.18-0.28) and 0.12 (0.09-0.17),32.21 (23.72-43.75) and 20.23 (14.33-28.55),and 0.911 8 and 0.788 8,respectively.Conclusion The combined detection of troponin and copeptin has high sensitivity,which may reduce the rate of missed diagnosis of AMI.However,the detection of troponin alone has high specificity and diagnostic accuracy.%目的 评价肌钙蛋白联合和肽素对急性心肌梗死(acute myocardial infarction,AMI)早期诊断的临床价值.方法 采用荟萃(meta)分析法,全面检索PubMed、CNKI、万方、维普等中英文数据库,收集建库至2016年5月的关于肌钙蛋白联合和肽素对AMI早期诊断的研究,用Meta-Disc1.4软件进行分析.结果 纳入19篇文献,共计11 176例研究对象.按随机效应模型计算(95％ CI),肌钙蛋白单独检测及肌钙蛋白联合和肽素检测,对AMI早期诊断的敏感性、特异性、阳性似然比、阴性似然比、诊断比值比(DOR)、曲线下面积(AUGROC)分别为77％(75％～79％)、92％(91％～93％);0.85(0.85 ～0.86)、0.60(0.59～0.61);5.78(4.01 ～8.32)、2.25(1.98 ～2.55);0.22(0.18 ～0.28)、0.12(0.09 ～0.17);32.21(23.72 ～43.75)、20.23(14.33～28.55);0.911 8、0.788 8.结论 肌钙蛋白联合和肽素具有更高的敏感性,可以减少漏诊率,但单独检测具有更高的特异性和诊断准确性.