可溶性fms样酪氨酸激酶1与胎盘生长因子的比值用于前瞻性预测子痫前期的荟萃分析

Clinical significance of ratio of soluble fms-like tyrosine kinase-1 and placenta growth factor to prospectively predict preeclampsia: a meta-analysis

目的使用荟萃分析研究血可溶性fms样酪氨酸激酶1(sFlt-1)与胎盘生长因子(PlGF)比值(sFlt-1/PlGF)用于前瞻性预测子痫前期的价值及准确性。方法在PubMed、ResearchGate、Embase和万方数据库中检索发表日期截止至2018年4月的相关文章。纳入标准包括:前瞻性研究,纳入子痫前期和非子痫前期人群;sFlt-1及PlGF在诊断子痫前期之前检查;可获得真阳性、假阳性、假阴性和真阴性事件数。使用Q检验和I^2统计评估研究异质性。使用双变量混合效应逻辑回归模型进行统计分析。结果纳入12项研究,共9261名孕妇(622例子痫前期和8639例非子痫前期)。研究间存在异质性[I^2=97%(95% CI 94%~99%),Q=57.70,P<0.01]。合并敏感度和特异度分别为83%(95% CI 73%~89%)和87%(95% CI 80%~92%)。合并阳性似然比和阴性似然比为6.4(95% CI 4.0~10.3)和0.20(95% CI 0.12~0.32)。合并诊断比值比为27.60(95% CI 10.36~73.67)。Deeks漏斗图显示没有明显的发表偏倚(P>0.05)。综合受试者工作特征(SROC)曲线的曲线下面积(AUC)为0.92(95% CI 0.89~0.94)。结论血sFlt-1/PlGF是早期预测子痫前期的有效方法,应进行大规模前瞻性队列研究以验证其有效性。

Objective To investigate the clinical significance of blood soluble fms-like tyrosine kinase-1 ( sFlt-1)/ placenta growth factor (P1GF) ratio for prospectively predicting preeclampsia (PE) by meta-analysis. Methods PubMed, ResearchGate, Embase and WanFang databases were searched up to April 2018. Main inclusion criteria:①prospective studies which enrolled both PE and no-PE population,②blood sFIt-l/PIGF ratio must be tested before the diagnosis of PE,③studies must provide or give enough data of true positive, false positive, false negative and true negative events numbers. Heterogeneity was evaluated using the Q-test and I^2 statistic. The odds ratios were pooled using bivariate mixed-effects logistic regression modeling. Results Twelve studies with 9261 pregnant women (622 PE and 8639 non-PE) were included. Heterogeneity was substantial: I^2 = 97 %(95% CI 94%. 99%),Q=57. 70, P<0.01. The pooled sensitivity and specificity were 83%(95% CI 73%.89%) and 87%(95% CI 80%.92%), respectively. The pooled positive likelihood ratio and negative likelihood ratio were 6. 4 (95% CI 4.0-10.3) and 0. 20 (95% CI 0. 12 -0. 32), respectively. The pooled diagnostic odds ratio was 27. 60 (95% CI 10.36-73.67). Deeks funnel plots showed no obvious publishing bias (P>0. 05). Area under curve (AUC) of summary receiver operating characteristic curve (SROC) was 0. 92(95% CI 0. 89-0. 94). Conclusion The ratio of blood sFIt-l/PIGF is a promising method to predict PE. Further large-scale cohort studies are needed to verify its validity.