血清胱抑素C评估对比剂肾病的Meta分析

Diagnostic value of serum Cystatin C for contrast-induced nephropathy:A Meta-analysis

目的运用Meta分析评价血清胱抑素C(Cystain C,Cys C)在临床中诊断对比剂肾病(contrast media induced nephropathy,CIN)的价值,并探讨其意义。方法电子检索PubMed、EM--base、Ovidsp,中国生物医学文献数据库、中国知网、万方数据、维普中文科技期刊数据库等多个中英文数据库,根据选择标准逐层筛选出符合要求的文献。随后采用诊断性试验准确性质量评价工具(quality assessment of diagnostic accuracy studies,QUADAS)工具对纳入的文献研究进行质量评估,并对其进行数据提取分析等,通过Meta-DiSc软件计算纳入研究的合并灵敏度、特异度等指标,同时绘制受试者工作特征曲线评价Cys C的总体诊断特性。结果按照选择标准有9项国内外研究被纳入进行此次分析,其中涉及2 165例患者。Meta分析结果显示血清Cys C在临床中诊断CIN的合并灵敏度与特异度分别为92%和89%均较高,合并阳性似然比与阴性似然比分别为7,33和0.12,合并诊断比值比为71,14,SROC曲线下面积为0,9539(其值愈趋近于1则表明该诊断试验的可靠性愈强),Q指数=0,8958。提示血清CysC对于早期的CIN具有良好诊断能力,在临床中可通过检测血清Cys C的浓度水平来评估放射性对比剂对肾小球滤过功能的损害程度。结论目前研究表明,临床中与血清肌酐相比较,血清Cys C能更敏感的反映早期对比剂的肾毒性,对CIN有一定的诊断价值及临床意义。然而,该研究的可靠性仍需多中心的大样本临床研究得到进一步的证实。

Objective To evaluate the diagnostic value of serum Cystatin （Cys） C for contrast- induced nephropathy （CIN） in the clinical practice by Meta-analysis and discuss its meaning. Methods The PubMed, EMbase, Ovidsp, The Chinese Biomedical Literature Database, CNKI, Wanfang, VIP and other databases were searched~ According to the requirements the retrieved literatures were screened step by step. The quality of the selected literatures was assessed by the instrument of quality assessment of diagnostic accuracy studies （QUADAS）. The data of the selected literatures were ex- tracted and analyzed using Meta-DiSc software to calculate their pooled sensitivity, specificity and oth- er indices. The diagnostic features of Cys C for CIN were evaluated by drawing symmetric receiver op- erator characteristic （SROC） curve. Resulls According to the requirements there were 9 articles in- cluding 2165 patients. The Meta-analysis showed that the pooled sensitivity and specificity of serum Cys C to diagnose CIN were 92% and 89%, the pooled positive likelihood ratio and negative likelihood ratio were 7. 33 and 0. 12, the pooled diagnostic odds ratio was 71.14, the area under the SROC curve was 0. 9539, and Q index was 0. 8958, showing that serum Cys C had good diagnostic capabilities for contrast media in the early and that the extent of damage of eGFR could be assessed by testing serum Cys C level clinically. Conclusions The present study suggests that as compared with serum creatinine clinically, serum Cys C is more sensitive to reflect renal toxicity of contrast media in the early. So to some extent serum Cys C has the diagnostic value. But the reliability of the study needs to be proved by the clinical multi-center study with a lot of samples.