血清总胆汁酸与甘胆酸水平诊断妊娠期肝内胆汁淤积症能力的Meta分析

Meta Analysis of the Ability of Total Bile Acid and Cholyglycine to Diagnose Intrahepatic Cholestasis of Pregnancy

目的评估总胆汁酸(total bile acid,TBA)与甘胆酸(cholylglycine,CG)对妊娠期肝内胆汁淤积症(intrahepatic cholestasia of pregnany,ICP)的诊断能力。方法检索PubMed,Embase,Cochrane,CNKI,维普和万方数据库自建库至2020年2月的相关文献,纳入符合标准的文献;运用诊断精确性研究的质量鉴定标准(quality assessment of diagnostic accuracy studies-2,QUADAS-2)进行文献质量评价;计算灵敏度、特异度及受试者工作特征曲线下面积(area under the cure,AUC),判断总胆汁酸与甘胆酸的诊断能力。结果共纳入8项研究总胆汁酸、甘胆酸诊断妊娠期肝内胆汁淤积症的灵敏度分别为0.81(95%CI:0.72~0.88)和0.93(95%CI:0.9~0.95);特异度依次为0.93(95%CI:0.87~0.97)和0.97(95%CI:0.91~0.99);AUC分别为0.93(95%CI:0.90~0.95)和0.96(95%CI:0.94~0.98)。结论总胆汁酸和甘胆酸均是诊断妊娠期肝内胆汁淤积症的有效指标,且甘胆酸的诊断能力高于总胆汁酸。

Objective To evaluate the diagnostic ability of total bile acid(TBA)and cholyglycine(CG)in intrahepatic cholestasis of pregnancy(ICP).Methods PubMed,Embase,Cochrane,CNKI,VIP and Wanfang databases were searched until February 2020 for relevant literatures,and literatures meeting the criteria were included.Quality Assessment of Diagnostic Accuracy Studies-2(QUADAS-2)was used for literature quality evaluation.The sensitivity,specificity and Area Under the Cure(AUC)were calculated to determine the diagnostic ability of TBA and CG.Results A total of eight studies were included in this analysis.The sensitivity of TBA and CG in the diagnosis of ICP were 0.81(95%CI:0.72~0.88)and 0.93(95%CI:0.9~0.95),the specificity were 0.93(95%CI:0.87~0.97)and 0.97(95%CI:0.91~0.99),and the AUC were 0.93(95%CI:0.90~0.95)and 0.96(95%CI:0.94~0.98),respectively.Conclusion Both TBA and CG are effective indicators for the diagnosis of ICP and the diagnostic ability of CG is higher than that of TBA.