中性粒细胞胞质抗体对溃疡性结肠炎诊断价值的系统评价

Diagnostic value of antineutrophil cytoplasmic antibodies in patients with ulcerative colitis： a metaanalysis

目的评价中性粒细胞胞质抗体（ANCA）诊断溃疡性结肠炎（UC）的价值。方法电子检索以中国生物医学文献数据库、中国生物医学期刊文献数据库、中国学术期刊全文数据库与中文科技期刊全文数据库为主，进行文献检索，再根据已发表文献中的参考文献追溯进行手工检索，发表时间截止至2007年11月。按确定的纳入标准筛选文献，对纳入的文献进行质量评价，运用Cochrane协作网诊断与筛查小组推荐的综合受试者工作特征（SROC）曲线法，以敏感性、特异性、准确性、阳性预测值（PPV）、阴性预测值（NPV）及似然比（LR）等指标进行荟萃分析。结果总计10篇文献的10项研究中381例UC患者符合纳入标准。经荟萃分析，ANCA诊断UC的敏感性及特异性分别为52．2％和99．0％；阳性预测值及阴性预测值分别为98．O％和68．7％；阳性似然比及阴性似然比分别为52．2和0．5。结论ANCA是与UC显著正相关的一个免疫学指标，ANCA阳性有利于UC的诊断，是诊断UC的一个辅助手段，但不能敏感地筛查患者。

Objective To evaluate the diagnostic value of antineutrophil cytoplasmic antibodies （ANCA） in patients with ulcerative colitis （UC）. Methods Articles related to diagnosis of UC by ANCA test, published before November 2007, were retrieved in the databanks such as Chinese BioMedical Disc, Chinese Medical Current Contents, China National Knowledge Intrastructurre, and VIP databank. Related journals were searched manually. Meta-analysis was performed by summary receiver operating characteristic curve recommended by Diagnostic and Screening Group of the Cochrane Collaboration Web with the parameters such as sensitivity, specificity, accuracy, predictive values and likelihood ratio. Results Totally 10 studies including 381 patients met the inclusion criteria. Meta-analysis showed that the sensitivity and specificity of ANCA to the diagnosis of UC were 52. 2% and 99. 0% respectively. The positive and negative predictive values （ PPV and NPV） were 98.0% and 68.7% respectively. Meanwhile, the positive and negative likelihood ratio （ ＋ LR and - LR） were 52.2 and 0.5, respectively. Conclusions ANCA is an immunological index related to UC. Positive ANCA helps diagnose UC, but is not sensible enough to screen UC.