本文關(guān)鍵詞： 呼出氣一氧化氮 FENO 哮喘 診斷　出處：《山西醫(yī)科大學(xué)》2013年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的：采用薈萃分析的方法，評(píng)價(jià)呼出氣一氧化氮（FENO）診斷支氣管哮喘（哮喘）的準(zhǔn)確性。 方法：檢索Pubmed、the cochrane library,the embase以及中國(guó)知網(wǎng)數(shù)據(jù)庫(kù)，全面收集探討FENO診斷哮喘的相關(guān)文獻(xiàn)，采用診斷試驗(yàn)質(zhì)量評(píng)價(jià)（QUADAS）工具對(duì)入選文獻(xiàn)進(jìn)行質(zhì)量評(píng)價(jià)，通過(guò)Deeks法在STATA（12.0）軟件中檢測(cè)是否具有發(fā)表偏倚，提取四格表相關(guān)數(shù)據(jù)，使用Meta-Disc （1.4）軟件對(duì)其進(jìn)行異質(zhì)性檢驗(yàn)，并進(jìn)行異質(zhì)性回歸分析，最后合并靈敏度、特異度、陽(yáng)性似然比、陰性似然比、診斷比值比等各項(xiàng)指標(biāo)，計(jì)算AUC值，并描繪綜合受試者工作特征曲線。 結(jié)果：共有16篇文獻(xiàn)總計(jì)19項(xiàng)研究入選，入選文獻(xiàn)總體質(zhì)量評(píng)價(jià)較高，其中某些文獻(xiàn)質(zhì)量較低的原因主要集中于QUADAS工具的條目1、3、4、11，即研究對(duì)象的入選、金標(biāo)準(zhǔn)的具體方案、待評(píng)價(jià)試驗(yàn)和金標(biāo)準(zhǔn)之間的時(shí)間間隔、是否使用盲法等方面。納入的各項(xiàng)研究基本不存在發(fā)表偏倚(即bias其p=0.3540.05）。異質(zhì)性分析顯示敏感度、特異度等各項(xiàng)指標(biāo)的p值均明顯小于0.05，即各研究間具有異質(zhì)性，回歸分析后未找出異質(zhì)性原因，故采用隨機(jī)效應(yīng)模型合并各統(tǒng)計(jì)指標(biāo)，，最終得出敏感度、特異度、陽(yáng)性似然比、陰性似然比、診斷比數(shù)比的數(shù)值依次為61%、82%、3.87、0.39、10.78，AUC值為0.8175。 結(jié)論：FENO診斷哮喘的敏感度較低，特異性和總體診斷效能中等。在臨床上，F(xiàn)ENO可用于輔助診斷哮喘、減少哮喘的漏診以及降低支氣管激發(fā)試驗(yàn)的風(fēng)險(xiǎn)。
[Abstract]:Objective: to evaluate the diagnostic accuracy of exhaled nitric oxide (FENO) in bronchial asthma (Asthma) by meta-analysis. Methods: the relevant literature on FENO diagnosis of asthma was collected by searching Pubmedthe cochrane library#en0# the embase and China knowledge net database, and the selected literatures were evaluated by using the diagnostic test quality evaluation tool (QUADASA). The Deeks method was used to detect publication bias in Stata 12.0) software. The data of four tables were extracted, the heterogeneity was tested by Meta-Disc 1.4) software, and the heterogeneity regression analysis was carried out. Finally, sensitivity, specificity, positive likelihood ratio were combined. The negative likelihood ratio and diagnostic ratio ratio were used to calculate the AUC value and to depict the integrated operating characteristic curve of the subjects. Results: a total of 19 studies of 16 articles were selected, and the overall quality of the selected literature was evaluated high. The reasons for the lower quality of some documents were mainly focused on the entry of QUADAS tool, I. e., the selection of the study subjects and the specific scheme of the gold standard. The time interval between the test to be evaluated and the gold standard, whether the blind method was used or not. There was basically no publication bias in the various studies included (i.e., bias, p0.3540.05). Heterogeneity analysis showed sensitivity. The p value of each index, such as specificity, was obviously less than 0.05, that is, there was heterogeneity among the studies, but the reason of heterogeneity was not found after regression analysis, so the random effect model was used to combine the statistical indexes, and finally the sensitivity, specificity, positive likelihood ratio were obtained. The value of negative likelihood ratio and diagnostic ratio were 61and 82in turn, and the AUC value was 0.8175.The value of AUC was 0.8175.The value of AUC was 3.87 ~ 0.39 ~ 10.78%. Conclusion the sensitivity, specificity and overall diagnostic efficacy of FENO are low, and FENO can be used to assist the diagnosis of asthma, reduce the risk of missed diagnosis of asthma and reduce the risk of bronchial provocation test.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類(lèi)號(hào)】：R562.25

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本文編號(hào)：1545136