尿胰蛋白酶原-2与尿液淀粉酶早期诊断急性胰腺炎的循证评估

Evidence-Based Evaluation of Trypsinogen-2 and Urine Amylase in the Early Diagnosis of Acute Pancreatitis

目的采用循证医学的方法评估尿胰蛋白酶原-2(TPS-2)和尿液淀粉酶(UAmy)早期诊断急性胰腺炎(AP)的诊断价值与诊断效能,为临床医生和检验人员选择AP生化标志物提供最佳临床决策证据。方法检索MEDLINE、EMBASE、中国生物医学文献数据库(CBMDISC)、中国生物医学期刊文献数据库(CMCC)、中文期刊全文数据库(CNKI)等数据库,按照纳入标准收集TPS-2与UAmy诊断AP的研究文献,采用QUADAS量表进行严格的文献质量评价,利用MetaDisc软件进行异质性分析及定量合成,绘制SROC曲线,计算相应的验后概率。结果39篇TPS-2与UAmy诊断AP的研究结果异质性分析,前者无明显异质性(P=0.5641,I2=0%);后者有中等程度的异质性(P=0.0086,I2=38.5%)。合并敏感度Sen分别为93%(95%CI:92%～94%)与81%(95%CI:79%～83%);合并特异度Spe分别为94%(95%CI:94%～95%)与82.0%(95%CI:81%～83%);SROCAUC分别为0.9788(SE=0.0024)与0.8680(SE=0.0084),差异有统计学意义,前者的综合诊断效能优于后者。TPS-2与UAmy结果阳性时诊断AP的验后概率分别约为56.88%与26.62%,阴性验后概率分别为0.69%与2.38%。结论检测尿液TPS-2诊断AP比UAmy具有更高的诊断价值,可作为AP诊断的过筛试验,阴性结果有99.31%的概率可排除AP的可能性。

Objective To review the situation of using TPS-2 and UAmy in early diagnosis of acute pancreatitis （AP）, and provide evidence for clinicians in the decision-making. Methods Data were obtained from MEDLINE, EMBASE, Chinese biomedical literature database （CBMDISC） and CNKI. Quality of the full text literatures was evaluated using QUADAS tables. Heterogeneity analysis and quantitative of synthesis were performed using Meta Disc software. SROC curves were constructed and the corresponding posterior probability was calculated. Results 39 relevant articles were studied. There was no significant heterogeneity（P=0.05641 ,P=0）was found in the former and moderate heterogeneity （P=0.0086,P=38.5%） was found in the latter. The summary sensitivity was 93% （95%CI： 92%-94%） in the former and 81.0%（95%CI：79%-83%） in the latter. The summary specificity was 94%（95%CI：94%-95%） in the former and 82.0%（95%CI：81%-83%） in the latter. The SROC AUC was 0.9788（SE=0.0024） in the former and 0.8680 （SE=0.0084） in the latter. The heterogeneity was significant statistically. The former has higher comprehensive diagnosis performance than the latter. TPS-2 and UAmy with the positive results in diagnosing AP of the posterior probability were about 56.88% and 26.62%, posterior probabilities of their negative results were 0.69 percent and 2.38 percent. Conclusion Urinary TPS-2 has a higher diagnostic value in diagnosing AP than UAmy. It can be used as a marker in the diagnostic screening tests.