心肌损伤标志物辅助诊断病毒性心肌炎的Meta分析
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摘要
目的评价心肌损伤标志物辅助诊断病毒性心肌炎(VMC)的临床价值。方法系统检索2012年12月～2018年3月中国生物医学文献数据库和中国知网等数据库有关心肌损伤标志物辅助诊断VMC的研究文献。文献质量评价采用NOS量表。结果本研究共纳入9个研究。Meta分析结果提示,诊断为VMC的敏感性(SEN)为94%,95%可信区间为0.87～0.98,说明漏诊率为6%。特异性(SPE)为90%,95%可信区间为0.83～0.95,说明误诊率为10%。阳性预测值为9.8,95%可信区间为5.4～17.7,说明心肌损伤标志物辅助诊断VMC为阳性时,可疑患者诊断为VMC的可能性大。阴性预测值为0.06,说明心肌损伤标志物排除可疑患者为VMC的可能性大。诊断优势比为159,说明心肌损伤标志物辅助诊断VMC为阳性的机会是阴性的159倍。ROC曲线下面积为0.97,说明其诊断效能很高。结论心肌损伤标志物确实有辅助诊断病毒性心肌炎的临床价值。还需要大量临床研究来证实这些结果。
Objective To assess the myocardial injury marker in clinical diagnosis of viral myocarditis(VMC).Methods From December 2012 to March 2018,Chinese biomedical literature database(CBM) and China national knowledge network(CNKI) and other databases were searched systematically for the research literature on myocardial injury markers to assist in the diagnosis of VMC.Newcastle-Ottawa Scale(NOS) was used for literature quality evaluation.Results A total of 9 studies were included in this study.The results of meta-analysis indicated that the sensitivity(SEN) of VMC diagnosis was 94%,and the 95% confidence interval was 0.87-0.98,indicating that the rate of missed diagnosis was 6%.The specificity(SPE) was 90%,and the 95% confidence interval was 0.83-0.95,indicating that the misdiagnosis rate was 10%.The positive predictive value was 9.8,and the 95% confidence interval was 5.4-17.7,it indicated that when the myocardial injury markers assist in the diagnosis of VMC was positive,suspicious patients were more likely to be diagnosed with VMC.Negative predictive value was 0.06,it indicated that the possibility of myocardial injury markers excluding suspicious patients as VMC was high.The diagnostic odds ratio was 159,it indicated that myocardial injury markers were 159 times more likely to assist in the diagnosis of VMC positive than negative.The area under the ROC curve was 0.97,it indicated that the diagnostic efficiency was high.Conclusion Myocardial injury marker is indeed valuable in auxiliary diagnosis of viral myoarditis.But much more studies are needed to approve these results.
Objective To assess the myocardial injury marker in clinical diagnosis of viral myocarditis(VMC).Methods From December 2012 to March 2018,Chinese biomedical literature database(CBM) and China national knowledge network(CNKI) and other databases were searched systematically for the research literature on myocardial injury markers to assist in the diagnosis of VMC.Newcastle-Ottawa Scale(NOS) was used for literature quality evaluation.Results A total of 9 studies were included in this study.The results of meta-analysis indicated that the sensitivity(SEN) of VMC diagnosis was 94%,and the 95% confidence interval was 0.87-0.98,indicating that the rate of missed diagnosis was 6%.The specificity(SPE) was 90%,and the 95% confidence interval was 0.83-0.95,indicating that the misdiagnosis rate was 10%.The positive predictive value was 9.8,and the 95% confidence interval was 5.4-17.7,it indicated that when the myocardial injury markers assist in the diagnosis of VMC was positive,suspicious patients were more likely to be diagnosed with VMC.Negative predictive value was 0.06,it indicated that the possibility of myocardial injury markers excluding suspicious patients as VMC was high.The diagnostic odds ratio was 159,it indicated that myocardial injury markers were 159 times more likely to assist in the diagnosis of VMC positive than negative.The area under the ROC curve was 0.97,it indicated that the diagnostic efficiency was high.Conclusion Myocardial injury marker is indeed valuable in auxiliary diagnosis of viral myoarditis.But much more studies are needed to approve these results.
引文
[1]史晓娟,王品品,谭鑫.小儿病毒性心肌炎诊断中血清高敏C反应蛋白、肌酸激酶同工酶以及心肌肌钙蛋白I联合检测的价值[J].心肺血管病杂志,2018,37(3):218-220,224
[2]Zeng X,Zhang Y,Kwong JS,et al.The methodological quality assessment tools for preclinical and clinical studies,systematic review and meta-analysis,and clinical practice guideline:a systematic review[J].J Evid Based Med,2015,8(1):2-10.
[3]张群辉,谭彩春,谢小慧,等.B超辅助诊断乳腺癌的Meta分析[J].西北国防医学杂志,2018,39(3):170-173.
[4]周伟梁,曾凡杰,秦伟毅,等.心肌损伤标志物检测在诊断病毒性心肌炎中的价值[J].现代预防医学,2015,42(23):4406-4408.
[5]严虹,洪素华.心肌肌钙蛋白I、肌酸激酶同工酶及高敏C反应蛋白检测与儿童病毒性心肌炎诊断的临床研究[J].中国卫生标准管理,2015,6(12):28-30.
[6]何恩萍,全晖.心肌肌钙蛋白I、肌酸激酶同工酶和C反应蛋白联合检测对儿童病毒性心肌炎的诊断价值[J].内蒙古中医药,2014,33(34):35.
[7]张海波,赵立华.三种指标联合检测在小儿病毒性心肌炎诊断中的应用价值[J].中国地方病防治杂志,2014,29(S2):114-115.
[8]胡孝彬,向小节,郭晓聪,等.高敏肌钙蛋白T对儿童病毒性心肌炎诊断价值探讨[J].检验医学,2014,29(4):307-311.
[9]钟斌才.hs-CRP、CK-MB mass和cTn I联合检测在小儿病毒性心肌炎诊断中的价值[J].海南医学院学报,2014,20(7):980-982,987.
[10]王桂兰.CK-MB、cTn I和hs-crp联合检测对儿童病毒性心肌炎诊断价值[J].中国实用医药,2013,8(20):39-40.
[11]李云,李新,魏荣.心肌肌钙蛋白I、肌酸激酶同工酶质量及高敏C反应蛋白在小儿病毒性心肌炎中的诊断价值[J].疑难病杂志,2012,11(12):910-912.
[12]翟淑波,刘仕成,孙景辉,等.病毒性心肌炎的发病机制、诊断和治疗[J].实用儿科临床杂志,2010,25(22):1762-1764
[13]Chon H,Lee S,Yoon SY,et al.SERS-based competitive immunoassay of troponin I and CK-MB markers for early diagnosis of acute myocardial infarction[J].Chem Commun(Camb),2014,50(9):1058-1060.
[14]李玉佳,卢伟,杜侃.磷酸肌酸钠联合利巴韦林治疗小儿病毒性心肌炎的临床疗效及其对患儿心肌酶水平的影响[J].吉林大学学报(医学版),2018,44(1):137-141.
[15]马进爱.心肌损伤标志物联合检测对急性病毒性心肌炎的诊断价值探讨[J].临床医学研究与实践,2017,2(9):126-127.
[16]黄晶,李国慧,黄慧,等.病毒性心肌炎与支原体肺炎患儿心肌损伤标志物水平的检验意义[J].现代生物医学进展,2016,16(17):3329-3333.
[17]严虹,洪素华.心肌肌钙蛋白I、肌酸激酶同工酶及高敏C反应蛋白检测与儿童病毒性心肌炎诊断的临床研究[J].中国卫生标准管理,2015,6(12):28-30.
[18]罗玉兰,叶久明,胡世蓉,等.动态心电图与心肌损伤标志物诊断急性病毒性心肌炎的价值[J].中国煤炭工业医学杂志,2018,21(3):293-297.
[19]王继东,吴颖.益心解毒汤联合常规西药治疗病毒性心肌炎的心电图疗效及对心肌损伤标志物水平的影响[J].四川中医,2018,36(3):94-96.
[2]Zeng X,Zhang Y,Kwong JS,et al.The methodological quality assessment tools for preclinical and clinical studies,systematic review and meta-analysis,and clinical practice guideline:a systematic review[J].J Evid Based Med,2015,8(1):2-10.
[3]张群辉,谭彩春,谢小慧,等.B超辅助诊断乳腺癌的Meta分析[J].西北国防医学杂志,2018,39(3):170-173.
[4]周伟梁,曾凡杰,秦伟毅,等.心肌损伤标志物检测在诊断病毒性心肌炎中的价值[J].现代预防医学,2015,42(23):4406-4408.
[5]严虹,洪素华.心肌肌钙蛋白I、肌酸激酶同工酶及高敏C反应蛋白检测与儿童病毒性心肌炎诊断的临床研究[J].中国卫生标准管理,2015,6(12):28-30.
[6]何恩萍,全晖.心肌肌钙蛋白I、肌酸激酶同工酶和C反应蛋白联合检测对儿童病毒性心肌炎的诊断价值[J].内蒙古中医药,2014,33(34):35.
[7]张海波,赵立华.三种指标联合检测在小儿病毒性心肌炎诊断中的应用价值[J].中国地方病防治杂志,2014,29(S2):114-115.
[8]胡孝彬,向小节,郭晓聪,等.高敏肌钙蛋白T对儿童病毒性心肌炎诊断价值探讨[J].检验医学,2014,29(4):307-311.
[9]钟斌才.hs-CRP、CK-MB mass和cTn I联合检测在小儿病毒性心肌炎诊断中的价值[J].海南医学院学报,2014,20(7):980-982,987.
[10]王桂兰.CK-MB、cTn I和hs-crp联合检测对儿童病毒性心肌炎诊断价值[J].中国实用医药,2013,8(20):39-40.
[11]李云,李新,魏荣.心肌肌钙蛋白I、肌酸激酶同工酶质量及高敏C反应蛋白在小儿病毒性心肌炎中的诊断价值[J].疑难病杂志,2012,11(12):910-912.
[12]翟淑波,刘仕成,孙景辉,等.病毒性心肌炎的发病机制、诊断和治疗[J].实用儿科临床杂志,2010,25(22):1762-1764
[13]Chon H,Lee S,Yoon SY,et al.SERS-based competitive immunoassay of troponin I and CK-MB markers for early diagnosis of acute myocardial infarction[J].Chem Commun(Camb),2014,50(9):1058-1060.
[14]李玉佳,卢伟,杜侃.磷酸肌酸钠联合利巴韦林治疗小儿病毒性心肌炎的临床疗效及其对患儿心肌酶水平的影响[J].吉林大学学报(医学版),2018,44(1):137-141.
[15]马进爱.心肌损伤标志物联合检测对急性病毒性心肌炎的诊断价值探讨[J].临床医学研究与实践,2017,2(9):126-127.
[16]黄晶,李国慧,黄慧,等.病毒性心肌炎与支原体肺炎患儿心肌损伤标志物水平的检验意义[J].现代生物医学进展,2016,16(17):3329-3333.
[17]严虹,洪素华.心肌肌钙蛋白I、肌酸激酶同工酶及高敏C反应蛋白检测与儿童病毒性心肌炎诊断的临床研究[J].中国卫生标准管理,2015,6(12):28-30.
[18]罗玉兰,叶久明,胡世蓉,等.动态心电图与心肌损伤标志物诊断急性病毒性心肌炎的价值[J].中国煤炭工业医学杂志,2018,21(3):293-297.
[19]王继东,吴颖.益心解毒汤联合常规西药治疗病毒性心肌炎的心电图疗效及对心肌损伤标志物水平的影响[J].四川中医,2018,36(3):94-96.