【摘要】 目的系统评价血清抗C1q抗体在中国人群狼疮肾炎(lupus nephritis,LN)诊断中的价值。方法计算机检索PubMed、EMbase、CNKI、The Cochrane Library、VIP和WanFang Data数据库,搜集血清中抗C1q抗体在中国人群中诊断LN的相关诊断性试验,检索时限均为建库至2015年3月1日。由2位评价员独立筛选文献、提取资料,并采用QUADAS工具评价纳入研究的方法学质量后,采用Meta-Disc 1.4软件及Stata 11.0软件进行Meta分析。结果最终纳入11个研究,共1 084例系统性红斑狼疮(systemic lupus erythematosus,SLE)患者,其中LN患者474例。Meta分析结果显示,抗C1q抗体诊断LN的合并敏感度、特异度、诊断比值比、阳性似然比和阴性似然比分别为0.67[95%CI(0.63,0.71)]、0.69[95%CI(0.65,0.74)]、5.09[95%CI(3.29,7.85)]、2.18[95%C(I 1.75,2.72)]和0.48[95%CI(0.39,0.60)],SROC曲线下面积(AUC)为0.749 6,Q*=0.693 1。抗C1q抗体诊断LN的平均漏诊率和平均误诊率分别为33.0%和31.0%。结论抗C1q抗体在诊断LN中具有一定诊断价值,但因存在较高的漏诊率和误诊率,尚不能单独用于LN的诊断,可作为LN的辅助诊断指标。受纳入研究数量和质量所限,上述结论尚需开展更多高质量研究予以验证。更多还原

【Abstract】 Objective To systematically review the diagnostic value of anti-C1 q antibodies for lupus nephritis(LN)in Chinese population. Methods We electronically searched databases including PubMed, EMbase, CNKI, The Cochrane Library, VIP and WanFang Data for diagnostic accuracy studies of anti-C1 q antibodies for LN in Chinese population from inception to 1st March, 2015. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies by QUADAS tool. Then, meta-analysis was performed by Meta-DiSc 1.4 software and Stata 11.0 software.Results A total of 11 studies involving 1 084 systemic lupus erythematosus(SLE) patients were included. Among them,474 patients were LN. The results of meta-analysis showed that: the pooled sensitivity, specificity, diagnostic odds ratio,positive likelihood ratio, and negative likelihood ratio of anti-C1 q in the diagnosis of LN were 0.67(95%CI 0.63 to 0.71), 0.69(95%CI 0.65 to 0.74), 5.09(95%CI 3.29 to 7.85), 2.18(95%CI 1.75 to 2.72), and 0.48(95%CI 0.39 to 0.60), respectively. The area under the curve(AUC) of SROC was 0.749 6 and the Q index value was 0.693 1. The average missed diagnosis rate was33.0% and the misdiagnosis rate was 31.0%. Conclusions Current evidence indicates that anti-C1 q antibodies may have some value in the diagnosis of LN. Because of the high missed diagnosis rate and the misdiagnosis rate, it could not be used to diagnose LN alone, and it only could be used as an adjuvant diagnostic indicator for LN. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.更多还原