粪便抗原检测儿童及青少年幽门螺杆菌感染诊断试验的系统评价

Diagnosis of H pylori infection in children and teenagers by H pylori stool antigen test:a systematic review

目的:采用Meta分析的方法评价幽门螺杆菌粪便抗原(H pylori stool antigen,HpSA)诊断儿童H pylori感染的价值,为临床应用提供依据.方法:以"幽门螺杆菌"、"儿童""诊断性试验"、"粪便抗原"、"诊断准确性"为检索词,通过联机检索CNKI中国期刊全文数据库、CBM中国生物医学文献数据库,文献追溯和手工检索的方法收集发表时间为1998-01/2008-05国内正式刊物上公开发表的有关评价粪便抗原检测H pylori感染准确性的相关研究文献.按确定的纳入、排除标准进行筛选,采用QUADAS工具对纳入的文献进行质量评价,应用MetaDisc1.4软件进行Meta分析,综合评价灵敏度、特异度、似然比、诊断优势比和SROC曲线下面积、Q*指数等指标.结果:共17篇文献符合纳入标准,各研究间具有同质性.共累计样本含量1466例,由金标准确诊H pylori感染737例,非感染729例.Meta分析结果显示各研究之间的一致性较高,粪便抗原诊断H pylori感染的合并敏感度、特异度分别是92%(95%CI90%-94%)和92%(95%CI90%-94%);合并阳性似然比、阴性似然比分别为11.44(95%CI8.83-14.81)和0.10(95%CI0.08-0.13).合并诊断优势比DOR126.14(84.84-187.55).绘制SROC曲线,估计SROC曲线下面积AUC=0.9696,Q*=0.9193.结论:粪便抗原检测儿童及青少年Hpylori感染的方法准确度较高.

AIM： To systemically evaluate the accuracy of H pylori stool antigen （HpSA） test for diagnosing H pylori infection in children and teenagers through meta-analysis. METHODS： Articles related to diagnosis of H pylori infection by HpSA test published from 1998-01 to 2008-05, were retrieved in CNKI and CBM. Related journals were also searched manually. Data analysis was conducted by software of MetaDisc1.4. Indexes reflecting accuracy of HpSA test for diagnosing H pylori infection such as sensitivity, specificity, likelihood ratio, diagnostic odds ratio were pooled using fixed effect model. SROC （Summary receiver operating characteristic） curve was used to summarize overall diagnostic performance. RESULTS： We included 17 studies which were homogeneous, including 1466 subjects among whom there were 737 people were positive and 729 were negative. Sensitivity of HpSA test for the diagnosis of H pylori infection was 92% （95%CI 90%-94%）, specificity was 92% （95%CI 90%-94%）, PLR（positive likelihood ratio）was 11.44 （95%CI 8.83-14.81）, NLR （negative likeli- hood ratio） was 0.10 （95%CI 0.08-0.13）, DOR （diagnostic odds ratio） was 126.14（95%CI 84.84-187.55）. The area under SROC curve was 0.9696. Q index was 0.9193. CONCLUSION： HpSA test as a non-invasive test is a highly accurate method to diagnose H pylori infection in children and teenagers.