4种筛查问卷对慢性阻塞性肺疾病诊断价值的网状Meta分析

Screening accuracy for four common questionnaires of chronic obstructive pulmonary disease: a network meta-analysis

目的 系统评价常见慢性阻塞肺疾病(COPD)筛查问卷对COPD的诊断价值。方法 计算机检索The Cochrane Library、Web of Science、PubMed、EMBase、CNKI、WanFang Data和VIP数据库,搜集有关COPD筛查问卷准确性的诊断性试验,检索时限均从建库至2022年1月31日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Meta-disc 1.4和Stata 15.0软件进行网状Meta分析。结果 共纳入28个研究,涉及4种筛查问卷。网状Meta分析结果表明,灵敏度排序:CDQ_(17)>LFQ>COPD-PS_(4)>CDQ_(20)>COPD-SQ>COPD-PS_(5);特异度排序:COPD-SQ>COPD-PS_(5)>CDQ_(20)>CDQ_(17)>COPD-PS_(4)>LFQ。亚组分析表明,在国内CDQ_(17)的灵敏度最高,CDQ_(20)的特异度最强;在国外LFQ的灵敏度最高,COPD-PS_(5)的特异度最强。结论 当前有限证据显示,CDQ和LFQ的灵敏度较高但特异度差,COPD-SQ和COPD-PS的特异度较强但灵敏度不佳,针对我国COPD患者的筛查建议优选CDQ。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective To systematically review the diagnostic value of common screening questionnaires for chronic obstructive pulmonary disease (COPD).Methods The Cochrane Library,Web of Science,PubMed,EMbase,CNKI,WanFang Data and VIP databases were electronically searched to collect diagnostic studies on the effectiveness of COPD screening questionnaires from inception to January 31 2022.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies,then network meta-analysis was performed by using Metadisc 1.4 and Stata 15.0 software.Results A total of 28 studies involving 4 screening questionnaires were included.The results of the network meta-analysis showed that,sensitivity sorting was CDQ_(17)>LFQ>COPD-PS_(4)>CDQ_(20)>COPD-SQ>COPD-PS_(5),the specificity sorting was COPD-SQ>COPD-PS_(5)>CDQ_(20)>CDQ_(17)>COPD-PS_(4)>LFQ.Subgroup analysis showed the sensitivity of CDQ_(17)and specificity of CDQ_(20)were the highest in China,the sensitivity of LFQ and specificity of COPD-PS5were the highest in foreign countries.Conclusion Current evidence suggests that CDQ and LFQ have high sensitivity but poor specificity,while COPD-SQ and COPD-PS have strong specificity but poor sensitivity.In China,CDQ is recommended for screening of COPD patients.Due to limited quality and quantity of the included studies,more highquality studies are needed to verify the above conclusion.