血浆醛固N／肾素活性比值对筛选原发性醛固酮症价值的文献质量评价

Assessing the quality of studies on screening primary aldosteronism by using plasma aldosterone to renin activity ratio

目的评价国内外关于应用血浆醛固酮／肾素活性比值（ARR）诊断原发性醛固酮症（PA）的文献质量。方法计算机检索Cochrane图书馆（1962—2007．12）、PubMed（1970—2007．12）、VIP（1989—2007．12）、万方（1982～2007．12）、CBMdisc（1978—2007．12），纳入应用ARR诊断PA的所有诊断性研究文献，按QUADAS（Quality Asse—ssment of Diagnostic Accuracy Studies）质量评价标准由两名研究者独立进行文献质量评价，如遇分歧，讨论解决。结果共纳入14篇相关文献，质量评价结果表明，大多数文献与QUADAS质量评价标准符合率不高。其中9篇病例谱未包含各种病例及易混淆病例，8篇未清楚描述研究对象的纳入排除标准，3篇金标准不能准确区分有病无病状态，13篇均没有采用盲法比较诊断性试验与金标准的结果。结论国内外关于应用ARR诊断PA的诊断性研究文献质量在病例选择、金标准选择、盲法比较、偏倚控制等方面需进一步完善。

Objective To assess the quality of international studies on using aldosterone to renin activity ratio （ARR） to diagnose primary aldosteronism. Methods We searched the Cochrane Library（ 1962 -2007. 12 ）, PubMed （ 1970 - 2007.12 ）, VIP （ 1989 - 2007.12 ）, Wan Fang database （ 1982 - 2007.12 ）, CBMdisc （ 1978 -2007.12） systematically. Language was limited to Chinese and English. The Quality Assessment of Diagnostic Accuracy Studies（QUADAS） was used to assess the quality of induced diagnostic studies by two reviewers independently. Results Fourteen studies were included and assessed. We found that most of the studies were not met with QUADAS items. Nine studies didn＇t chose correct cases that included miscellaneous cases and confused cases. Eight studies didn＇t describe internalized or exclusive references clearly. The gold standard in three studies could not discriminate whether the diagnosis of patients was confirmed or not. Thirteen studies did not use blind trial to compare the diagnostic test and the gold standard. Conclusions The studies using ARR to diagnose primary aldosteronism should be improved in patients selection, the gold standard selection, comparison of blind trial and bias control.