miRNA-21对糖尿病肾病诊断效能的Meta分析

Meta-analysis of the Diagnostic Efficacy of miRNA-21 in Diabetic Kidney Disease

目的 用Meta分析评价miRNA-21作为糖尿病肾病生物学标志物的诊断价值。方法 检索Embase、PubMed、Web of Science、CNKI、万方、VIP、CBM数据库,搜集miRNA-21与糖尿病肾病的相关性研究,检索时间从建库至2021年4月。根据纳入排除标准筛选文献,提取资料,然后采用Revman5.3中的Quadas-2量表进行质量评价,利用Stata15.1以及Meta-Disc1.4软件对纳入研究进行Meta分析并对纳入文献进行偏倚分析及异质性检验。结果 最终纳入7篇文献,共涉及882例样本,其中糖尿病肾病患者525例,对照病例357例。Meta分析结果显示,miRNA-21诊断糖尿病肾病合并敏感度为62%(95%CI:58%~68%),合并特异性为73%(95%CI:68%~78%)。合并阳性似然比为2.50(95%CI:1.79~3.50),合并阴性似然比为0.43(95%CI:0.31~0.60)。合并诊断价值比为6.29(95%CI:3.36~11.79),SROC曲线下AUC面积为0.7889。诊断性试验Deek′s漏斗图显示不存在发表偏倚。研究中有无肾活检可能是异质性一个重要的来源,亚组分析发现miRNA-21在有肾活检报告的研究中有更高的诊断效能(AUC为0.8802)。因此,miRNA-21在糖尿病肾病的诊断效价可能接近肾活检。结论 miRNA-21可作为快速诊断非侵入性糖尿病肾病的新型生物学标志物。

Objective Toevaluate the diagnostic value of miRNA-21 as a biomarker for diabetic kidney disease using Meta-analysis.Methods Embase,Pubmed,Web of Science,CNKI,Wanfang,VIP and CBM databases were searched to collect studies on the association of miRNA-21 with diabetic kidney disease from the time of database construction to April 2021.The literature was screened according to the inclusion and exclusion criteria,the data were extracted,and then the quality was evaluated using the Quadas-2 scale in Revman5.3,and the Meta-analysis of the included studies and the bias analysis and heterogeneity test of the included literature were performed using Stata 15.1 as well as Meta-Disc 1.4 software.Results Seven papers involving a total of 882 samples,including 525 cases of patients with diabetic kidney disease and 357 control cases,were finally included in the literature.The results of Meta-analysis showed that the pooled sensitivity,specificity,positive likelihood ratio and negative likelihood ratio of miRNA-21 for diagnosis of diabetic kidney disease was 62%(95%CI:58%-68%),73%(95%CI:68%-78%),2.50(95%CI:1.79-3.50) and 0.43(95% CI:0.31-0.60),respectively.The pool diagnostic odds ratio was 6.29(95%CI:3.36-11.79),and the area under the summary receiver operator characteristic curve(AUC) was 0.7889.The diagnostic test Deek′s funnel plot showed no publication bias.The presence or absence of renal biopsy in the study may be an important source of heterogeneity,subgroup analysis revealed higher diagnostic efficacy of miRNA-21 in studies with renal biopsy reports(AUC was 0.8802),so the diagnostic efficacy of miRNA-21 in diabetic kidney disease may be close to that of renal biopsies.ConclusionmiRNA-21 can be used as a novel biomarker for rapid diagnosis of non-invasive diabetic kidney disease.