心肌损伤标志物辅助诊断病毒性心肌炎的Meta分析  

Myocardial injury marker in diagnosis of viral myocarditis:a Meta-analysis

作　　者：李雁卓 徐琳[1] 张群辉[1,2] LI Yan-zhuo;XU Lin;ZHANG Qun-hui(The Second Ward of Department of Cardiovascular Medicine, Guangzhou General Hospital of Guangzhou Military Command, PLA, Guangdong Province, Guangzhou 510010, China;Graduate School, Guangzhou University of Chinese Medicine, Guangdong Province, Guangzhou 510006, China)

机构地区：[1]广州军区广州总医院心血管内科二病区,广东广州510010 [2]广州中医药大学研究生院,广东广州510006

出　　处：《中国当代医药》2019年第4期11-14,共4页China Modern Medicine

基　　金：广东省广州市科技计划项目(201704020079)

摘　　要：目的评价心肌损伤标志物辅助诊断病毒性心肌炎(VMC)的临床价值。方法系统检索2012年12月～2018年3月中国生物医学文献数据库和中国知网等数据库有关心肌损伤标志物辅助诊断VMC的研究文献。文献质量评价采用NOS量表。结果本研究共纳入9个研究。Meta分析结果提示,诊断为VMC的敏感性(SEN)为94%,95%可信区间为0.87～0.98,说明漏诊率为6%。特异性(SPE)为90%,95%可信区间为0.83～0.95,说明误诊率为10%。阳性预测值为9.8,95%可信区间为5.4～17.7,说明心肌损伤标志物辅助诊断VMC为阳性时,可疑患者诊断为VMC的可能性大。阴性预测值为0.06,说明心肌损伤标志物排除可疑患者为VMC的可能性大。诊断优势比为159,说明心肌损伤标志物辅助诊断VMC为阳性的机会是阴性的159倍。ROC曲线下面积为0.97,说明其诊断效能很高。结论心肌损伤标志物确实有辅助诊断病毒性心肌炎的临床价值。还需要大量临床研究来证实这些结果。Objective To assess the myocardial injury marker in clinical diagnosis of viral myocarditis (VMC). Methods From December 2012 to March 2018, Chinese biomedical literature database (CBM) and China national knowledge network (CNKI) and other databases were searched systematically for the research literature on myocardial injury markers to assist in the diagnosis of VMC. Newcastle-Ottawa Scale (NOS) was used for literature quality evaluation. Results A total of 9 studies were included in this study. The results of meta-analysis indicated that the sensitivity (SEN) of VMC diagnosis was 94%, and the 95% confidence interval was 0.87-0.98, indicating that the rate of missed diagnosis was 6%. The specificity (SPE) was 90%, and the 95% confidence interval was 0.83-0.95, indicating that the misdiagnosis rate was 10%. The positive predictive value was 9.8, and the 95% confidence interval was 5.4-17.7, it indicated that when the myocardial injury markers assist in the diagnosis of VMC was positive, suspicious patients were more likely to be diagnosed with VMC. Negative predictive value was 0.06, it indicated that the possibility of myocardial injury markers excluding suspicious patients as VMC was high. The diagnostic odds ratio was 159, it indicated that myocardial injury markers were 159 times more likely to assist in the diagnosis of VMC positive than negative. The area under the ROC curve was 0.97, it indicated that the diagnostic efficiency was high. Conclusion Myocardial injury marker is indeed valuable in auxiliary diagnosis of viral myoarditis. But much more studies are needed to approve these results.

关 键 词：病毒性心肌炎 心肌损伤标志物 肌酸激酶同工酶 肌钙蛋白 

分 类 号：R542.21[医药卫生—心血管疾病]