国内HLA-B27诊断强直性脊柱炎价值的Meta分析

Diagnostic Value of HLA-B27 for Ankylosing Spondylitis in China: A Meta-analysis

目的系统评价国内HLA-B27诊断强直性脊柱炎(AS)的价值。方法计算机检索Pub Med、The Cochrane Library(2015年第4期)、EMbase、CNKI、CBM、VIP、Wan Fang Data数据库中有关国内HLA-B27诊断AS的诊断性试验,检索时限均为从建库至2015年4月13日。由2位研究者独立筛选文献、提取数据和评价纳入研究的方法学质量后,采用Meta-Disc 1.4软件进行Meta分析。分别计算合并敏感度(Sen)、特异度(Spe)、阳性似然比(+LR)、阴性似然比(–LR)、诊断比值比(DOR)及汇总受试者工作特征曲线(SROC)下面积(AUC),并按照HLA-B27不同检测方法进行亚组分析。结果最终纳入18篇文献,包括22个研究,共计3 670例AS患者和28 389例健康对照。Meta分析结果显示:Sen合并=0.92[95%CI(0.90,0.93)]、Spe合并=0.94[95%CI(0.94,0.95)]、+LR合并=16.22[95%CI(13.63,19.29)]、–LR合并=0.08[95%CI(0.06,0.10)]、DOR合并=256.49[95%CI(168.25,391.00)],AUC=0.98。亚组分析结果显示:流式细胞仪(FCM)与序列特异性引物聚合酶链反应(PCR-SSP)检测HLA-B27对AS诊断准确性的差异无统计学意义(Z=7.92,P=0.08)。结论当前证据显示,HLA-B27对中国人AS诊断价值较高,FCM法和PCR-SSP法检测HLA-B27对AS的诊断准确性相当。但受纳入研究质量所限,特别未能纳入疑似患者,本研究结论尚需进一步开展高质量的诊断准确性研究进行验证。

Objective To systematically review the diagnostic value of HLA-B27 for ankylosing spondylitis （AS） in China. Methods We searched PubMed, The Cochrane Library （Issue 4, 2015）, EMbase, CNKI, CBM, VIP and WanFang data from inception to April 2015, to collect diagnostic studies about HLA-B27 for AS in China. Two reviewers independently screened literature, extracted data and assessed the methodological quality of included studies. Then meta-analysis was performed using Meta-Disc 1.4 software. Pooled sensitivity （Sen）, specificity （Spe）, positive likelihood ratio （＋LR）, negative likelihood ratio （-LR）, diagnostic odds ratio （DOR）, and area under the curve （AUC） of summary receiver operating characteristic curve （SROC） were calculated to assess the diagnostic value of individual diagnostic tests. Subgroup analysis was stratified by detection methods of HLA-B27. Results A total of 18 studies involving 22 comparisons, with 3 670 AS patients and 28 389 health controls were finally included. The results of meta-analysis showed that the pooled Sen, Spe, ＋LR, -LR, and DOR were 0.92 （95%CI 0.90 to 0.93）, 0.94 （95%CI 0.94 to 0.95）, 16.22 （95%CI 13.63 to 19.29）, 0.08 （95%CI 0.06 to 0.10）, and 256.49 （95%CI 168.25 to 391.00）, respectively. The AUC of SROC was 0.98. The result of subgroup analysis showed that there was no significant difference for flow cytometry （FCM） and Polymerase Chain Reaction with Sequence-Specific Primer （PCR-SSP） in HLA-B27 detection for AS （Z=7.915, P=0.960）. Conclusions Current evidence indicates that HLA-B27 detection is of great diagnostic value for AS. At present, FCM and PCR-SSP shows no significant difference in HLA-B27 detection for AS. Due to the limitation of the quality of included studies, and the exclusion of the suspected patients, higher quality studies are needed to verify the above conclusion.