抗环瓜氨酸肽抗体对幼年特发性关节炎诊断价值的Meta分析

Diagnostic value of anti-cyclic citrullinated peptide antibody for juvenile idiopathic arthritis: a Meta-analysis

目的通过Meta分析系统评价抗CCP抗体在幼年特发性关节炎(JIA)中的诊断价值。方法检索万方数据库、维普中文科技期刊(VIP)数据库、中国知网期刊数据库(CNKI)、中国医学生物文献数据库、Embase、PubMed、Cochrane图书馆等数据库,收集抗CCP抗体在JIA中诊断价值的文献,提取数据,进行质量评价,采用Stata 12.0软件对纳入文献进行异质性分析,通过计算敏感度(SEN)、特异度(SPE)以及拟合综合受试者工作特征(SROC)曲线并计算曲线下面积(AUC)等指标,综合评估该抗体的诊断价值。结果共纳入30篇中英文文献,分析显示纳入文献存在阈值效应并具有较高异质性,采用混合效应模型计算得出合并敏感度[0.16,95%CI(0.11,0.22)]、特异度[0.99,95%CI(0.98,0.99)]及AUC[0.86,95%CI(0.83,0.89)];探究异质性来源发现RF阳性的多关节亚型敏感度[0.65,95%CI(0.51,0.76)]远高于其他亚型;同时,抗CCP抗体在区分JIA患儿和健康儿童[0.99,95%CI(0.98,1.00)]的能力优于区分其他疾病患儿[0.74,95%CI(0.70,0.77)],差异具有统计学意义(Z=7.9,P<0.01)。结论抗CCP抗体虽不能完全作为JIA的早期诊断指标,但在疾病的初筛、早期治疗等方面能够提供一定的指导性作用;同时对RF阳性的多关节亚型的鉴别诊断具有一定的临床应用价值。

Objective To estimate the diagnostic value of anti-cyclic citrullinated peptide(CCP)antibody for juvenile idiopathic arthritis(JIA)by Meta-analysis.Methods The databases,including Wanfang Database,VIP citation databases,China National Knowledge Infrastructure(CNKI),China Biology Medicine disc,Excerpta Medica Database(EMbase),PubMed,Cochrane Library,were searched for the studies related to the diagnostic value of anti-CCP antibody for JIA.After extracting literature data and assessing the articles by Quality Assessment of Diagnostic Accuracy Studies tool.The sources of heterogeneity,sensitivity(SEN),specificity(SPE),area under the curve(AUC)were calculated by the summary receiver operator characteristic(SROC)curve by Stata 12.0 software.Results A total of 30 literature reports were included in this Meta-analysis.The heterogeneity and the threshold effect of the included articles were tested,a mixed effects model was selected to calculate the pooled weighted SEN[0.16,95%CI(0.11,0.22)],SPE[0.99,95%CI(0.98,0.99)]and AUC[0.86,95%CI(0.83,0.89)].The sensitivity estimates were highly heterogeneous,which was partially explained by the higher sensitivity in the rheumatoid factor-positive polyarthritis(RF+PA)subtypes[0.65,95%CI(0.51,0.76)]than in the other subtypes.The ability of diagnostic differentiation between of JIA and healthy children was better than the diagnostic differentiation between JIA and other patients(Z=7.9,P<0.01).Conclusion Although anti-CCP antibody cannot be used as an early diagnostic indicator of JIA,it can provide a certain guiding role in the initial screening and early treatment of the disease.CCP has clinical value in the differential diagnosis of RF+PA subtypes.