缺血修饰清蛋白对急性冠脉综合征诊断价值的荟萃分析

Diagnosis value of a meta-analysis of ischemia-modified albumin in acute coronary syndrome

目的系统评价缺血修饰清蛋白(IMA)对急性冠脉综合征(ACS)的诊断价值。方法计算机检索PubMed、Em-base、ScienceDirect、Springer、Ovid、万方、维普等数据库中的文献,按照纳入排除标准筛选文献,采用QUADAS工具评价纳入文献质量,采用SPSS 17.0、Meta-Disc 1.4及Review Manager 4.2进行统计分析。结果最终纳入13篇文献,包括8篇中文文献及5篇英文文献,样本量为2 381例,异质性检验示存在非阈值效应,采用随机效应模型合并统计量。13项研究汇总灵敏度为78%(75%～80%),汇总特异度为66%(63%～68%),汇总阳性似然比为2.57(1.69～3.61),汇总阴性似然比为0.28(0.16～0.48)。SROC曲线下面积为0.848 9。IMA对ACS诊断的灵敏度(72%)高于肌钙蛋白(cTnT)(39%),IMA的特异度(57%)低于cTnT(72%)。结论 IMA对ACS诊断的灵敏度明显高于cTnT,因而可以作为诊断ACS的新指标。同时,IMA值位于正常水平时对排除ACS有更高的临床价值。

Objective To assess the value of ischemia-modified albumin（IMA） in diagnosing acute coronary syndrome.Methods PubMed,Embase,ScienceDirect,Springer,Ovid,WanFang,WeiPu and so on were searched for studies about IMA in the diagnosis of ACS.We screened studies identified for inclusion according to the criteria of inclusion and exclusion.Statistical analysis was performed by SPSS 17.0、Meta-Disc 1.4 and Review Manager 4.2.Results Thirteen studies,including eight Chinese and six English reports,were identified,where 2 381 patients were reported.Heterogeneity test results showed non-threshold effect.Thus,we used the random effect model to combine the data.The pooled sensitivity and specificity of IMA were 78%（75%-80%） and 66%（63%-68%）,respectively.The pooled positive and negative likelihood ratios were 2.57（1.69-3.61） and 0.28（0.16-0.48）,respectively.The area under the SROC curve（AUC） was 0.848 9.The sensitivity of the IMA（78%） was higher than that of cTnT（39%）.By contrast,the specificity of the IMA（57%） is lower than that of cTnT（72%）.Conclusion The IMA sensitivity is obviously higher than that of cTnT,which indicated that we could use IMA as a new biomarker of myocardial necrosis to diagnose ACS.Especially,the negative IMA has a high value for excluding ACS.