D-二聚体对肺血栓栓塞症诊断价值的Meta分析

发布时间：2018-06-03 08:52

本文选题：肺血栓栓塞症 + D-二聚体　；参考：《武汉大学学报(医学版)》2014年06期

【摘要】：目的:评价D-二聚体在肺血栓栓塞症(PTE)中的诊断价值。方法:计算机检索PubMed、Embase、CENTRAL、the ISI Web of Knowledge Databases、VIP、CNKI、CBM和万方数据库,查找所有D-二聚体诊断肺血栓栓塞症的中英文文章,检索时限均为建库至2014年2月28日。同时手检纳入文献的参考文献。按纳入排除标准由两人独立进行文章的筛选、资料提取和质量评价后,采用Meta-Disc 1.4和Revman 5.2软件进行Meta分析,并采用QUADAS-2系统进行证据质量评价。结果:共纳入16个研究,9 565例患者。Meta分析结果显示:各研究间存在较大异质性(I2=88.7%,P0.01),合并诊断优势比为13.89(95%CI为6.77-28.49),合并敏感度为0.90(95%CI为0.88-0.91),合并特异度为0.54(95%CI为0.53-0.55),阳性似然比为1.95(95%CI为1.56-2.42),阴性似然比为0.16(95%CI为0.09-0.31),合并受试者工作特征曲线下面积为0.78。其中9项研究采用EILSA法检测,EILSA法敏感度、阴性似然比分别为0.98、0.07;7项研究采用SimpliRED法检测,SimpliRED法敏感度、阴性似然比分别为0.71、0.36。结论:现有文献的Meta分析结果表明D-二聚体对PTE的诊断具有较高的阴性排除价值,对于疑似肺栓塞患者的筛查,ELISA法优于SimpliRED法。
[Abstract]:Objective: to evaluate the diagnostic value of D-dimer in pulmonary thromboembolism (PTEs). Methods: a computer-based search of the ISI Web of Knowledge databases and CNKI CBM and Wanfang database was conducted to find all the articles in Chinese and English for diagnosis of pulmonary thromboembolism (PTE). The searching time limit was until February 28, 2014. At the same time, the manual examination was included in the reference literature. According to the inclusion and exclusion criteria, the two individuals independently carried out the selection of articles, data extraction and quality evaluation, then Meta-Disc 1.4 and Revman 5.2 software for Meta analysis, and QUADAS-2 system for the evaluation of the quality of evidence. Results: a total of 9 565 patients were included in 16 studies. Meta-analysis results showed that there was a large heterogeneity of I288.7, the odds ratio of combined diagnosis was 6.77-28.49G, the sensitivity of 0.90(95%CI was 0.88-0.91g, the specificity of 0.54(95%CI was 0.53-0.55, and the positive likelihood ratio was 0.53 -0.55. The 1.95(95%CI was 1.56-2.42, the negative likelihood ratio was 0.09-0.31, and the area under the operating characteristic curve was 0.78. Nine of the studies used EILSA to detect the sensitivity of EILSA, and the negative likelihood ratio was 0.98 ~ 0.07. The negative likelihood ratio was 0.71 ~ 0.36 by using SimpliRED method to detect the sensitivity of Simplired method. Conclusion: the results of Meta analysis show that D- dimer has a high negative exclusion value in the diagnosis of PTE, and the screening Elisa for suspected pulmonary embolism patients is superior to SimpliRED method.
【作者单位】：武汉大学人民医院呼吸内科;
【分类号】：R563.5

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