摘要
目的评价MELD-Na评分对我国HBV相关慢加急性肝衰竭短期预后的预测价值。方法检索Pub Med、Embase、中国知网、维普、万方等数据库2006年1月-2018年3月发表的中英文文献。应用诊断性试验准确性质量评价工具(QUADAS-2)评价文献质量,检验是否存在阈值效应。根据是否存在异质性分别采用随机效应模型或固定效应模型合并敏感度、特异度、阳性似然比、阴性似然比及诊断比值比,构建拟合受试者工作特征曲线,计算受试者工作特征曲线下面积(AUC)。采用Deek's漏斗图非对称检验评估是否存在发表偏倚。结果共有8项研究符合纳入标准。共计1386例患者纳入本研究,其中男1173例,占84.6%。各研究纳入患者平均41.3~46.9岁。异质性检验提示存在显著异质性,采用随机效应模型合并敏感度、特异度、阳性似然比、阴性似然比和诊断比值比分别为0.67[95%可信区间(95%CI):0.59~0.75]、0.77(95%CI:0.63~0.87)、2.89(95%CI:1.84~4.54)、0.43(95%CI:0.35~0.52)和7.32(95%CI:4.33~12.40)。计算AUC为0.75(95%CI:0.72~0.79)。Deek's漏斗图非对称检验提示不存在明显的发表偏倚。结论 MELD-Na评分对我国乙型肝炎相关慢加急性肝衰竭的短期预后具有一定的预测价值。
Objective To investigate the value of MELD combined with serum sodium concentration（MELD-Na） in predicting the short-term outcome of patients with HBV-related acute-on-chronic liver failure（ACLF） in China. Methods Pub Med,Embase,CNKI,VIP,and Wanfang Data were searched for related articles in English and Chinese published from January 2006 to March 2018. The second version of Quality Assessment of Diagnostic Accuracy Studies（QUADAS-2） was used to evaluate the quality of each article. The presence or absence of threshold effect was examined. According to the presence or absence of heterogeneity,a random effect model or a fixed effect model was used for pooling sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,and diagnostic odds ratio（DOR）. The receiver operating characteristic（ROC） curve was plotted and the area under the ROC curve（AUC） was calculated. The Deek＇s funnel plot asymmetry test was used to investigate the presence or absence of publication bias. Results A total of eight studies were included,with a total of 1386 patients,among whom there were 1173（84. 6%） male patients. The mean age of the patients included in these studies ranged from 41. 3 to 46. 9 years. The tests for heterogeneity showed significant heterogeneity between studies and a random effect model was used for pooling. The sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,and DOR were 0. 67（95% confidence interval [CI]： 0. 59-0. 75）,0. 77（95% CI： 0. 63-0. 87）,2. 89（95% CI： 1. 84-4. 54）,0. 43（95% CI： 0. 35-0. 52）,and 7. 32（95% CI： 4. 33-12. 40）,respectively. The AUC was 0. 75（95 CI： 0. 72-0. 79）. The Deek＇s funnel plot asymmetry test showed no significant publication bias. Conclusion MELD-Na score has a certain value in predicting the short-term outcome of patients with HBV-related ACLF in China.
作者
张辉
贾雷
姚士伟
崔培林
徐有青
ZHANG Hui;JIA Lei;YAO Shiwei(Department of Gastroenterology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100050,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2018年第9期1950-1955,共6页
Journal of Clinical Hepatology
基金
北京市优秀人才培养资助项目(2017000021469G217)
