呼出气一氧化氮检测对支气管哮喘诊断应用价值的Meta分析

发布时间：2018-08-07 11:43

【摘要】：目的:采取Meta分析的方式,评估呼出气一氧化氮检测在支气管哮喘诊断中的应用价值。方法:应用电子计算机检索万方、维普、中国知网、中国生物医学文献数据库(CBM)、the cochrane library、Pubmed、EMBASE数据库,全面收集1990年1月1日至2017年1月1日发表的FeNO与哮喘诊断有关的文献,并根据诊断试验质量评价-2标准对纳入文献进行质量评价,并应用Cochrane协作网提供RevMan5.3软件进行发表风险偏倚检测。提取文献数据,然后用Meta-Disc(1.4)统计软件进行Meta分析,并计算合并后的诊断比值比(DOR)、合并敏感度、合并特异度、合并阳性似然比和合并阴性似然比,进行合并受试者工作特征曲线(SROC)分析,得到合并SROC曲线下面积(AUC)。结果:共检索出文献1389篇,包括中文文献934篇,英文文献455篇,筛选后共有9篇文献符合标准,共1940例患者。入选文献总体质量较高,发表偏倚bias的t为-0.59,相应的p值为0.571。异质性检验结果:1.敏感度对数和1-特异度对数的spearman相关系数0.017,p=0.966;2.纳入研究间存在由非阈值效应引起的异质性,去除由非阈值效应引起的部分异质性,进行回归分析后仍未找到产生异质性原因,使用随机效应模型合并统计指标。FeNO阈值在15-25ppb之间,敏感度、特异度分别为0.74、0.70;FeNO阈值在26-35ppb之间,敏感度、特异度分别为0.60、0.86;FeNO阈值在36-45ppb之间,敏感度、特异度分别为0.80、0.80。合并后得出敏感度为74%、特异度为79%、阳性似然比值为3.63、阴性似然比值为0.29、诊断比数比的数值12.25、AUC值为0.8502。结论:1.FeNO是一种简单、安全的气道炎症检测方法,FeNO诊断哮喘的敏感度、特异性和总体诊断效能一般。在临床上,FeNO目前仍不能替代经典肺功能诊断哮喘地位,是较好的哮喘辅助诊断指标,应作进一步研究。2.FeNO值在36-45ppb之间对哮喘诊断更有指导意义。
[Abstract]:Objective: to evaluate the diagnostic value of exhaled nitric oxide (no) in bronchial asthma by Meta analysis. Methods: to search the database of Wanfang, Weipu, ChinaNet, (CBM) of Chinese biomedical literature database (CBM) the cochrane library Pubmedus EMBASE, and to collect the literature of FeNO related to asthma diagnosis published from January 1, 1990 to January 1, 2017. According to the diagnostic test quality evaluation-2 standard, the quality of the literature was evaluated, and the RevMan5.3 software was used to detect the risk bias of the publication. The literature data were extracted and Meta analysis was carried out with Meta-Disc (1.4) statistical software. The diagnostic ratio after the combination was calculated to be more sensitive, specific, positive and negative than that of (DOR),. The area (AUC). Under the combined SROC curve was obtained by (SROC) analysis of the combined subjects' operating characteristic curve. Results: a total of 1389 articles were retrieved, including 934 in Chinese and 455 in English. A total of 9 articles met the criteria after screening. A total of 1940 patients were selected. The overall quality of the selected literature was higher, the publication bias t was -0.59, the corresponding p value was 0.571. Heterogeneity test results: 1. The spearman correlation coefficient of the logarithm of sensitivity and the logarithm of 1-specificity was 0. 017 and 0. 966 / 2 respectively. There is heterogeneity caused by non-threshold effect and partial heterogeneity caused by non-threshold effect among the inclusion studies. After regression analysis, the cause of heterogeneity has not been found. Using the stochastic effect model to combine the statistical index. FeNO threshold between 15-25ppb, sensitivity, specificity were 0.74 ~ 0.70% Feno threshold in 26-35ppb, sensitivity, specificity were 0.60 ~ 0.86% Feno threshold in 36-45ppb, sensitivity and specificity were 0.80 ~ 0.80, respectively. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic ratio were 74, 79, 3.63, 0.29 and 0.8502, respectively. Conclusion Feno is a simple and safe method for the detection of airway inflammation. The sensitivity specificity and overall diagnostic efficacy of FeNO in the diagnosis of asthma are general. Feno is still not a substitute for classical pulmonary function in the diagnosis of asthma, and it is a better index for asthma diagnosis. 2. Feno should be studied further in the diagnosis of asthma. 2. Feno is more instructive in the diagnosis of asthma between 36-45ppb.
【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R562.25

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