胸水腺苷脱氨酶对结核性胸膜炎诊断价值的Meta分析

摘要

目的 系统评价胸腔积液腺苷脱氨酶(ADA)对结核性胸腔积液的诊断价值.方法 通过计算机检索Pubmed,Embase、Medline、Cochrane Library外文文献和万方医学、中国知网中文文献,全面收集胸水腺苷脱氨酶诊断结核性胸腔积液的相关研究,检索时限为2005年1月至2016年6月.由两位评价员分别独立筛选文献、提取资料和方法学评价后,采用Meta-Disc 1.4软件进行Meta分析.结果 最终纳入23个研究,共3312份病例.Meta分析结果表明,胸水ADA诊断结核性胸腔积液的敏感度(SEN)、特异度(SPE)、诊断优势比(DOR)的汇总值分别为SEN=0.876,95%CI=0.859~0.892、SPE=0.899,95%CI=0.885~0.912、似然比(LR)+=8.139,95%CI=6.644~10.327,LR-=0.172,95%CI=0.133~0.222、DOR=72.29,95%CI=44.771~116.75、曲线下面积(AUC)=0.9535.结论 胸腔积液ADA对结核性胸腔积液的临床诊断有较高的敏感度和特异度,胸腔积液ADA可作为诊断结核性胸腔积液的辅助指标,ADA的界限值方法是不同研究的异质性主要来源.%Objective To systematically review the diagnostic value of adenosine deaminase(ADA)of pleural effusion for tuberculous pleurisy.Methods We searched Pubmed,Embase,Medline,Cochrane Library,CNKI, CBMdise and Wanfang Database,comprehensive collection studies about the diagnostic value of ADA for tuberculous pleurisy from Jan.2005 to Jun.2016.Two reviewers screened literature according to the inclusion and exclusion criteria,extracted data,and assessed the quality of included studies.Meta-Disc 1 .4 was used to conduct the meta-analysis.Results A total of 23 studies(3312 cases)were finally included.The results of meta-analysis showed that the value of pooled sensitivity,specificity,LR+,LR-,diagnostic odds ratio(DOR)were SEN=0.876,95%CI =0.859-0.892;SPE=0.899,95%CI =0.885-0.912;LR+=8.139,95%CI =6.644-10.327;LR-=0.172,95%CI =0.133-0.222;DOR=72.29,95%CI =44.771-116.75;AUC=0.9535.Conclusion ADA determination is a sensitive and specific test for the diagnosis of tuberculous pleurisy.Pleural effusion ADA can be used as an auxiliary indicator in diagnosis of tuberculous pleural effusion.