血清抗-PLA2 R抗体对特发性膜性肾病诊断价值的meta分析

摘要

Objective:To investigate the value of serum anti-PLA2 R as a diagnostic marker of idiopathic membranous nephropathy( IMN).Methods:All available articles about serum anti-PLA2 R as a marker of IMN which were published at home and abroad from 2009.1 to 2013.12 were pooled from the databases of PubMed,Elsevier,Springer,CNKI,VIP and Wanfang database et al. The quality of the papers were evaluated by the quality assessment for studies of diagnostic accuracy studies( QUADAS).And then a meta-analysis was conducted by the statistical softwares of Meta-Disc and Stata.The diagnostic value of serum anti-PLA2 R in IMN was evaluated by the statistical indicators of pooled sensitivity, pooled specificity, pooled likelihood ratio and summary receiver operating characteristic curve( ROC curve).Sensitivity analysis was performed by reducing a paper in order,and publication bias was tested by Egger funnel plot.Results: Seven articles were selected to the meta-analysis according to the inclusion criteria and 967 cases were included in the study ( 454 IMN patients and 513 controls ).Heterogeneity test showed no heterogeneity threshold effect ( Spearman correlation coefficient was 0.107,P=0.819),but there was heterogeneity caused by non threshold effects(Cochrane-Q was 16.89,P=0.009 7).So random model was used to pool the effect size.The overall combined effect sizes:sensitivity was 69%,95%CI:0.65-0.73;specificity:98%,95%CI:0.96-0.99;pooled positive likelihood ratio 16.37,95%CI:4.06-65.95;pooled negative likelihood ratio 0.32,95%CI:0.24-0.43;AUC of SROC:0.854 0,Q*=0.785 0.Sensitivity analysis showed that this research was stable and reliable and Egger funnel plot showed little publication bias.Conclusion: Serum anti-PLA2 R is an useful biomarker to the diagnosis of IMN.%目的：探讨血清抗-PLA2 R抗体（ anti-PLA2 R）在特发性膜性肾病（ IMN）诊断中的价值。方法：检索PubMed、Elsevier、Springer、中国期刊全文数据库、中国科技期刊数据库、万方数字化期刊全文数据库等数据库中2009年1月至2013年12月国内外公开发表的关于血清anti-PLA2 R诊断特发性膜性肾病的相关文献，根据纳入和排除标准筛选文献并提取数据，采用诊断精确性研究的质量评估方法（ QUADAS）评价文献质量，通过Meta-Disc和Stata软件进行Meta分析。通过汇总后的敏感度、特异度、似然比及汇总受试者工作曲线（ ROC）综合评价血清anti-PLA2 R对IMN的诊断价值。采用依次减少一篇文献的方法进行敏感性分析，通过Egger漏斗图检验文献发表偏倚。结果：共筛选出7篇文献。累计病例967例，其中IMN患者454例，对照组513例。异质性检验提示不存在阈值效应引起的异质性（Spearman相关系数为0.107，P＝0.819），但存在非阈值效应引起的异质性（Cochrane-Q为16.89，P＝0.0097）。采用随机效应模型合并诊断指标。合并后的灵敏度为69％，95％CI：0.65～0.73，特异度为98％，95％CI：0.96～0.99。汇总阳性似然比16.37，95％CI：4.06～65.95，汇总阴性似然比0.32，95％CI：0.24～0.43。 SROC曲线显示AUC为0.8540，Q*指数为0.7850。敏感性分析显示本研究稳定可信，Egger漏斗图显示无明显发表偏倚。结论：血清anti-PLA2 R对诊断IMN具有重要的临床价值。