尿[TIMP-2]×[IGFBP-7]对心脏术后患者急性肾损伤早期预测价值的Meta分析

Meta-analysis on early predictive value of urinary TIMP-2 and IGFBP-7 product for acute kidney injury in cardiac postoperative patients

目的评估尿金属蛋白酶组织抑数因子-2(TIMP-2)与胰岛素样生长因子结合蛋白-7(IGFB-P7)的乘积对心脏手术患者术后急性肾损伤(AKI)的早期预测价值。方法检索EMBASE、Pubmed、Cochrane、Web of Science、CNKI、Sinomed、万方数据库。限定时间为2014年2月1日年至2018年2月1日。检索得到相关文献共138篇,经过严格的纳入排除,筛选文献并提取所需数据。按QUADAS-2质量评价标准评估文献。使用Meta-DiSc1.4软件进行数据分析,利用Stata12.0进行发表偏倚的检测。通过亚组分析、Meta回归、敏感性分析识别及处理异质性来源。结果最终筛选出文献10篇,总病例数659例,共发生AKI202例,未发生AKI457例。行异质性检测,发现Spearman相关系数为0.067(P=0.855),提示阈值效应所致异质性不明显。合并诊断比值比I2<25%,提示研究间非阈值效应不存在异质性。合并效应量显示尿[TIMP-2]×[IGFBP-7]预测心脏术后患者早期AKI的合并灵敏度为0.72(95%CI0.66~0.78)、特异度0.72(95%CI0.68~0.76)、诊断比值比8.12(95%CI5.46~12.08)、汇总AUC=0.8021,表明尿[TIMP-2]×[IGFBP-7]对心脏术后患者早期AKI有较好的预测价值。检测发表偏倚,提示发表偏倚不明显。行亚组分析显示样本量大小可能是异质性来源。Meta回归结果未提示明显异质性,敏感性分析显示本分析的稳健性尚可。结论尿[TIMP-2]×[IGFBP-7]对早期预测心脏术后患者AKI具有重要的临床价值,但仍需要进一步大样本临床实验证实。

Objective To assess the early predictive value of urinary TIMP-2 and IGFBP-7 product for postoperative acute kidney injury in cardiac postoperative patients.Methods EMBASE,Pubmed,Cochrane,Web of Science,CNKI,Sinomed and Wanfang database were searched.The limited time is from February 1,2014 to February 1,2018.A total of 138 articles related to “prediction of postoperative acute kidney injury in patients with heart-related surgery” were retrieved and 10 articles were screened out.The required data were extracted.QUADAS-2 quality evaluation criteria were used to evaluate the literature.Meta-DiSc 1.4 software was used for data analysis and publication bias was tested by Stata 12.0.Subgroup analysis,meta-regression,and sensitivity analysis were adopted to identify the sources of heterogeneity.Results Ten articles were screened out eventually and they related to a total number of 659 cases (AKI occurring,202 cases;and no AKI occurrence,457 cases).Heterogeneity test showed Spearman correlation coefficient of 0.067 (P=0.855),suggesting that the threshold effect of heterogeneity was not obvious.With meta-analysis it was found that,the pooled diagnostic odds ratio I 2 was <25%,suggesting that there was no heterogeneity in the non-threshold effect between studies.The combined effect of urine TIMP-2 and IGFBP-7 product for early predictionof AKI in postoperative patients with cardiac surgery showed sensitivity of 0.72 (95% CI 0.66~0.78),specificity of 0.72 (95% CI 0.68~0.76),diagnostic odds ratio of 8.12 (95% CI 5.46~12.08),pooled AUC = 0.8021,indicating thaturinary TIMP-2 and IGFBP-7 producthad good predictive value for early acute kidney injury in patients after cardiac surgery.The publication bias was not obvious.Subgroup analysis shows that the sample size might be the source of heterogeneity,the meta-regression results did not reveal significant heterogeneity,and sensitivity analysis showed that this method did not have poor robustness.Conclusions Urine TIMP-2 and GFBP-7 product has important clinical value in early predicting acute renal injury in patients after cardiac surgery,but it still needs further large-scale clinical studies to confirm.