血液外泌体来源miRNA对类风湿关节炎诊断价值的Meta分析  

A Meta-analysis of the Diagnostic Value of Blood Exosome-derived MicroRNAs for Rheumatoid Arthritis

作　　者：施雨燕 龚志贤[1] 李鑫[2] 张亮[3] 王文怡 徐美丽 艾坤[3] 刘梨[1] SHI Yuyan;GONG Zhixian;LI Xin;ZHANG Liang;WANG Wenyi;XU Meili;AI Kun;LIU Li(The Firs Hospital of Hunan University of Chinese Medicine,Changsha 410007,China;Hunan Key Laboratory of Chinese Medicine Diagnostics,Hunan University of Traditional Chinese Medicine,Changsha 410208,China;Hunan University of Chinese Medicine,Changsha 410208,China)

机构地区：[1]湖南中医药大学第一附属医院,湖南长沙410007 [2]湖南中医药大学中医诊断学湖南省重点实验室,湖南长沙410208 [3]湖南中医药大学,湖南长沙410208

出　　处：《标记免疫分析与临床》2024年第1期88-93,共6页Labeled Immunoassays and Clinical Medicine

基　　金：国家自然科学基金面上项目(编号:82074565,82274627);湖南省中医药管理局科研课题重点项目(编号:A2023010)。

摘　　要：目的 有研究发现血液外泌体(Exosomes)中的miRNA(microRNAs)在类风湿关节炎患者中存在异常表达,这可能成为RA诊断的潜在标志物。本研究的目的是系统评价血液外泌体来源的miRNA对类风湿关节炎(RA)的诊断价值。方法 利用计算机收集PubMed、Web of science、Embase、Cochrane Library、中国知网、万方、维普网、中国生物医学文献等数据库中有关外泌体诊断类风湿关节炎方面的文献,根据制定的文献检索策略筛选文献并提取文献中相关数据。采用诊断准确性研究的质量评价工具(quality assessment of diagnostic accuracy studies, QUADS-2)对纳入文献进行质量评价。应用RevMan 5.3、Meta-Disc 1.4软件与Stata 16.0软件进行Meta分析,计算合并灵敏度、特异性、阳性似然比、阴性似然比、诊断比值比等指标,利用受试者工作特征(ROC)曲线及曲线下面积(AUC)对其异质性与发表偏倚进行分析。结果计算机共检索出2 698篇文献,经过筛选后纳入文献共6篇,其中包含18种miRNA,Meta分析结果显示不存在由阈值效应引起的异质性,但存在由非阈值效应引起的异质性,故采用随机效应模型合并效应量,合并灵敏度为0.80(95%CI 0.73~0.86)、合并特异性为0.77(95%CI 0.73~0.80)、合并阳性似然比为3.5(95%CI 2.9~4.2)、合并阴性似然比为0.26(95%CI 0.18~0.36)、合并诊断比值比为14(95%CI 8~22)、受试者工作特征(ROC)曲线下面积AUC=0.82(95%CI 0.79~0.85)。结论 血液外泌体来源miRNA对类风湿关节炎(rheumatoid arthritis, RA)有较高诊断价值与意义,可作为诊断RA的新生标志物,但受目前文献数量及质量的限制,今后需要更多的临床研究加以验证。Objective To evaluate the performance of blood exosome-derived miRNAs in the early diagnosis of rheumatoid arthritis by using a meta-analysis method.Methods Literature on exosomes in the diagnosis of rheumatoid arthritis was collected from PubMed,Web of science,Embase,Cochrane Library,CNKI,and other databases.We used QUADS-2 to assess risk and bias among all enrolled studies.A meta-analysis was performed using Stata 16.0,RevMan 5.3,and Meta-Disc 1.4 software to calculate the combined SEN,SPE,PLR,NLR,DOR.The heterogeneity and publication bias were analyzed using SROC and AUC methods.Results A total of 2,698 articles were retrieved and six articles were included after screening process,which contained eighteen miRNAs.The random-effects model was used to combine the effect sizes and results were as following:the combined sensitivity of 0.80(95%CI 0.73-0.86),the specificity of 0.77(95%CI 0.73-0.80),PLR of 3.5(95%CI 2.9-4.2),NLR of 0.26(95%CI 0.18-0.36),DOR of 14(95%CI 8-22),and AUC=0.82(95%CI 0.79-0.85).Conclusion Blood exosome-derived miRNAs have high diagnostic values and significance for RA and can be used as a marker for the diagnosis of RA,but due to the limitations of the current quantity and quality of the literature,more clinical studies are needed for future validation.

关 键 词：外泌体 类风湿关节炎 诊断 META分析 

分 类 号：R593.22[医药卫生—内科学]