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血清YKL-40对肝纤维化分期诊断价值的Meta分析
Diagnostic value of serum YKL-40 for liver fibrosis stage: A meta-analysis
文章发布日期:2018年08月06日  来源:  作者:张艳芳, 杨馥宁, 车媛媛,等  点击次数:226次  下载次数:13次

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【摘要】:目的探讨血清YKL-40蛋白对肝纤维化分期的诊断价值,为慢性肝病肝纤维化的无创诊断提供参考。方法系统检索数据库包括PubMed、EMBASE、the Cochrane Library、Web of Science、CNKI等针对YKL-40诊断肝纤维化或者肝硬化临床价值的研究,使用质量评估方法(QUADAS-2)评价文献,采用Stata12.0软件对纳入研究进行综合定量评价,检验识别偏倚情况,分析异质性来源并且绘制森林图和汇总受试者工作曲线(SROC)。 结果最终纳入9篇文献,共1592例患者,其中 6篇文献对显著性肝纤维化(≥F2)进行研究;7篇对进展性肝纤维化(≥F3)进行研究。YKL-40诊断显著性肝纤维化(≥F2)的合并敏感度和特异度分别是0.78[95%可信区间(95%CI):0.69~0.85]、0.53(95%CI:0.33~0.72),阳性似然比为1.7(95%CI:1.0~2.7),阴性似然比为0.41(95%CI :0.21~0.76),优势比值比为4(95%CI:1~13 )、SROC曲线下面积(AUC)是0.76(95%CI:0.72~0.80)。YKL-40诊断进展性肝纤维化(≥F3)的合并敏感度和特异度分别是0.83(95%CI:0.76~0.89)、0.72(95%CI:0.62~0.80),阳性似然比为3.0(95%CI:2.0~4.4),阴性似然比为0.23(95%CI:0.14~0.37),诊断比值比为13(95%CI:5~30)、AUC为0.85(95%CI:0.82~088)。结论鉴于血清YKL-40在显著性肝纤维化和进展性肝纤维化方面的诊断价值有限,其成为新的、有效的诊断肝纤维化分期的血清标志物有待进一步验证。
【Abstract】:ObjectiveTo explore the diagnostic value of serum YKL-40 for liver fibrosis stage, and to provide a reference for noninvasive diagnosis of liver fibrosis in patients with chronic liver disease. MethodsWe searched PubMed, EMBASE, the Cochrane Library, Web of Science, and CNKI for studies on the clinical value of YKL-40 in the diagnosis of liver fibrosis or cirrhosis. The quality of studies was evaluated using the QUADAS-2 tool to assess the risk of bias. Comprehensive quantitative evaluation of the included studies was performed using Stata 12.0. The source of heterogeneity was analyzed, and the forest plot and summary receiver operating curve (SROC) were generated. ResultsA total of nine studies involving 1592 patients were included in the meta-analysis; six studies were conducted on significant fibrosis (≥F2), and seven studies were conducted on progressive fibrosis (≥F3). In the diagnosis of significant fibrosis (≥F2), YKL-40 had pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, odds ratio, and area under the SROC (AUC) of 078 (95% confidence interval [CI]: 0.69-0.85), 0.53 (95%CI: 0.33-0.72), 1.7 (95%CI: 1.0-2.7), 0.41 (95%CI: 0.21-0.76), 4 (95%CI: 1-13), and 0.76 (95%CI:0.72-0.80), respectively. In the diagnosis of progressive fibrosis (≥F3), YKL-40 had pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, odds ratio, and AUC of 0.83 (95%CI: 0.76-089), 0.72 (95%CI: 0.62-0.80), 3.0 (95%CI: 2.0-4.4), 0.23 (95%CI: 0.14-0.37), 13 (95%CI: 5-30), and 0.85 (95%CI: 082-0.88), respectively. ConclusionThe diagnostic value of serum YKL-40 for significant and progressive liver fibrosis is limited, so it may not be a new, effective serum marker for the staging of liver fibrosis.
【关键字】:肝硬化; 软骨蛋白聚糖类; 诊断; Meta分析
【Key words】:liver cirrhosis; aggrecans; diagnosis; Meta-analysis
【引证本文】:ZHANG YF, YANG FN, CHE YY, et al. Diagnostic value of serum YKL-40 for liver fibrosis stage: A meta-analysis[J]. J Clin Hepatol, 2018, 34(9): 1896-1900. (in Chinese)
张艳芳, 杨馥宁, 车媛媛,等. 血清YKL-40对肝纤维化分期诊断价值的Meta分析[J]. 临床肝胆病杂志, 2018, 34(9): 1896-1900.

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