抗聚丝蛋白抗体诊断类风湿性关节炎的Meta分析

Diagnosis of Rheumatoid Arthritis by Antifilaggrin Autoantibodies:A Meta-Analysis

目的评价抗聚丝蛋白抗体(AFA)对类风湿性关节炎(RA)诊断的准确性。方法计算机检索PubMed(1966～2010.8)、Cochrane Library(2010年第8期)、EMbase(1974～2010.8)、中国生物医学文献数据库(1978～2010.8)、CNKI(1994～2010.8)、VIP(1989～2010.8)和中华医学会数字化期刊库(1997～2010.8)等,并追索纳入研究的参考文献,查找AFA与修订的RA分类标准(ACR)比较诊断类风湿性关节炎的诊断性试验,依据QUADAS质量评价标准评价纳入研究的质量,采用Meta-Disc 1.4软件进行Meta分析。结果共纳入18篇文献,6 971例受试者。Meta分析结果显示:与ACR相比,AFA诊断RA的合并敏感度、特异度、阳性似然比、阴性似然比、诊断OR值和SROC分别为0.52(0.50,0.54)、0.93(0.92,0.94)、7.11(5.35,9.45)、0.53(0.48,0.60)、13.82(9.93,19.24)和0.8347。结论应用免疫印迹和ELISA法检测AFA时,其对RA的诊断效能高,有一定的临床应用前景。

Objective To evaluate diagnostic value of antifilaggrin autoantibodies （AFA） tor rheumatoid arthri- tis （RA）. Methods A systematic, comprehensive literature search was conducted in PubMed （1966 to 2010.8）, The Cochrane Library （issue 8, 2010）, EMbase （1974 to 2010.8）, CBM （1978 to 2010.8）, CNKI （1994 to 2010.8）, VIP （1989 to 2010.8） and Chinese Medical Association of Digital Periodicals （1997 to 2010.8）. The diagnosis studies on AFA versus the standards of American College of Rheumatology for RA were included. QUADAS items were used to evaluate the quality of the included studies. Meta-disc software （version 1.4） was used to analyze data. Sensitivity （SEN）, specificity （SPE）, pos- itive likelihood ratio （＋LR）, negative likelihood ratio （-LR） and summary receiver operating characteristic curve （SROC） were calculated to assess the diagnostic value of indi,~idual diagnostic tests. Residts A total of 18 articles were included, involving 6 971 cases of subjects from 7 countries. Results of meta-analysis showed that, compared with the standards of American College of Rheumatology, pooled SEN, SPE, ＋LR, -LR, and SROC curve of AFA were 0.52 （0.50, 0.54）, 0.93 （0.92, 0.94）, 7.11 （5.35, 9.45）, 0.53 （0.48, 0.60）, 13.82 （9.93, 19.24）, and 0.834 7, respectively. Conclusion IBT, ELISA detection of AFA are of high efficiency in the diagnosis of RA. However, the antigen from human breast skin is not conducive to dinical application.