尿胰蛋白酶原-2对急性胰腺炎早期诊断价值的系统评价  

Systematic Review of Urine Trypsinogen-2 in Early Diagnosis of Acute Pancreatitis

作　　者：曾方银[1] 刘杰[1] 张鹏[1] 郑磊[1] 王前[1] 

机构地区：[1]南方医科大学附属南方医院检验科,广州510515

出　　处：《循证医学》2010年第4期212-217,共6页The Journal of Evidence-Based Medicine

基　　金：广东省自然科学基金(9451051501003704)

摘　　要：目的评价尿胰蛋白酶原-2早期诊断急性胰腺炎的诊断价值。方法检索MEDLINE、EMBASE、中国生物医学文献数据库(CBMdisc)、中国生物医学期刊文献数据库(CMCC)、中文期刊全文数据库(CNKI)等数据库,收集关于尿胰蛋白酶原-2诊断急性胰腺炎的相关文献,进行质量评价,利用MetaDisc软件进行异质性分析、Meta分析并绘制综合受试者工作特征曲线。结果纳入符合要求的文献55篇,采用QUADAS量表进行严格的文献质量评价,Meta分析显示55篇文献结果存在轻度异质性(P=0.0987,I2=20.3%);合并敏感度为92.2%(95%可信区间91.1%～93.2%),合并特异度为94.1%(95%可信区间93.4%～94.7%),综合受试者工作特征曲线下面积为0.9784(标准误0.0023),表明其平均漏诊率和平均误诊率均较低(分别为7.8%和5.9%),检测结果为阴性时病人患急性胰腺炎的概率为0.69%。结论免疫层析法检测尿胰蛋白酶原-2是一项灵敏而特异的急性胰腺炎早期筛查指标,阴性结果基本可以排除急性胰腺炎的可能。Objective To evaluate the diagnostic value of urine trypsinogen-2 （TPS-2） in early diagnosing acute pancreatitis（AP）. Methods Retrieved the databases of MEDLINE, EMBASE, CBMdisc, CMCC and CNKI to achieve the researches on TPS-2 in diagnosing AP. Evaluated the quality of the articles and carried out the heterogeneity analysis and meta analyzed by the MetaDisc software, and then built the systematic receiver operating characteristic （SROC） curve. Results 55 researches were ruled in at last, the quality assessment was carried out by QUADAS and light heterogeneity （P=0.098 7,P=20.3%） was found in the 55 researches. As for diagnostic value of TPS-2 in diagnosing AP, the summary sensitivity was 92.2% （95%CI 91.1%-93.2%）; the summary specificity was 94.1% （95%CI 93.4%-94.7%）; and the area under the SROC curve （AUC）was 0.978 4（SE=0.002 3）. Therefore, the false negative rate and false positive rate were rather low （7.8% and 5.9% respectively）, the probability of positive diagnosis was only 0.69% when the TPS-2 assay turned to be negative. Conclusion High sensitivity and specificity were found in diagnosing AP with urine TPS-2, which was detected by the immunochromatographic method. TPS-2 detection was recommended to be the screen assay in diagnosing AP, and AP could probably be ruled out by the negative result.

关 键 词：胰蛋白酶原-2 急性胰腺炎 系统评价 诊断价值 

分 类 号：R576[医药卫生—消化系统] R446.12[医药卫生—内科学]