尿胰蛋白酶原-2与血清淀粉酶早期诊断急性胰腺炎诊断价值的循证评估  

Evidence-based evaluation of trypsinogen-2 and serum amylase in the early diagnosis of acute pancreatitis

作　　者：曾方银[1] 王前[1] 刘杰[1] 张鹏[1] 邓凡[2] 

机构地区：[1]南方医科大学附属南方医院检验科 [2]南方医科大学基础医学院细胞生物教研室,广东广州510515

出　　处：《国际检验医学杂志》2010年第11期1203-1206,共4页International Journal of Laboratory Medicine

基　　金：广东省自然科学基金(9451051501003704)

摘　　要：目的采用循证医学的方法评估尿胰蛋白酶原-2(TPS-2)和血清淀粉酶(SAmy)早期诊断急性胰腺炎(AP)的诊断价值与诊断效能,为临床医生和检验人员选择AP生化标志物提供最佳临床决策证据。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,按照纳入标准收集TPS-2与SAmy诊断AP的研究文献,采用QUADAS量表进行严格的文献质量评价,利用MetaDisc软件进行异质性分析及定量合成,绘制SROC曲线,计算相应的验后概率。结果 44篇TPS-2与SAmy诊断AP的研究结果异质性分析,前者有中等程度的异质性(P=0.0417,I2=28.7%),而后者无显著异质性(P=0.1133,I2=21%);合并敏感度Sen分别为93%(95%CI:91%～94%)与81%(95%CI:79%～83%);合并特异度Spe分别为94%(95%CI:93.0%～95.0%)与86%(95%CI:85.0%～87.0%);SROCAUC分别为0.9788(SE=0.0025)与0.8965(SE=0.0058),差异有统计学意义(P<0.05),前者的综合诊断效能优于后者。TPS-2与SAmy结果阳性诊断AP的验后概率分别为55.32%与30.78%,阴性验后概率分别为0.69%与1.96%。结论检测尿液TPS-2诊断AP比SAmy具有更高的诊断价值,可作为AP诊断的过筛试验,阴性结果有99.31%的概率可排除AP的可能性。Objective To review TPS-2 and SAmy in early diagnosis of acute pancreatitis （AP） by the evidence-based medicine and provide diagnostic value for clinicians in selecting and testing of biochemical markers of AP to provide the best evidence to clinical decision-making. Methods Retrieving the databases of MEDLINE,EMBASE,Chinese biomedical literature database （CBM- DISC） ,and CNKI,the full text literatures collected from diagnosing AP according to the including criteria and literature quality Evaluation through QUADAS tables, as welt as heterogeneity analysis and quantitative of synthesis using Meta Disc software,SROC curves drawing and the corresponding posterior probability calculation. Results 44 researches of TPS-2 and SAmy in diagnosing AP, moderate heterogeneity（P = 0.041 7,12 = 28.7 % ） was found in the former and no significant heterogeneity（P= 0.113 36,12 = 21% ） was found in the latter. The summary sensitivity was 93 % （95 % CI：91% - 94 % ）in the former and 81.0 % （95 % CI： 79.0 % 83.0 %） in the latter. The summary specificity was 94 % （95 % CI ： 93.0 % - 95.0 % ） in the former and 86.0 % （95 % CI ： 85.0%- 87.0%）in the latter. The SROC AUC was 0. 9788（SE=0. 002 5） in the former and 0. 8965（SE=0. 005 8） in the latter. The heterogeneity was significant different. The former has higher comprehensive diagnosis performance than the latter. TPS-2 and SAmy with the positive results in diagnosing AP of the posterior probability were about 55.32% and 30.78%, posterior probabilities of their negative results were 0.69% and 1.76 %, respectively. Conclusion Urine TPS：2 has higher diagnostic value in diagnosing AP than SAmy. It can be used as diagnostic screening tests, its negative result of 99.31 % probability can be helpful in excluding the possibility of AP.

关 键 词：革兰氏阴性菌 抗药性 细菌 基因型 寡核苷酸序列分析 实验室技术和方法 

分 类 号：R576[医药卫生—消化系统]