【摘要】：目的:采取Meta分析的方式,評估呼出氣一氧化氮檢測在支氣管哮喘診斷中的應(yīng)用價(jià)值。方法:應(yīng)用電子計(jì)算機(jī)檢索萬方、維普、中國知網(wǎng)、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(CBM)、the cochrane library、Pubmed、EMBASE數(shù)據(jù)庫,全面收集1990年1月1日至2017年1月1日發(fā)表的FeNO與哮喘診斷有關(guān)的文獻(xiàn),并根據(jù)診斷試驗(yàn)質(zhì)量評價(jià)-2標(biāo)準(zhǔn)對納入文獻(xiàn)進(jìn)行質(zhì)量評價(jià),并應(yīng)用Cochrane協(xié)作網(wǎng)提供RevMan5.3軟件進(jìn)行發(fā)表風(fēng)險(xiǎn)偏倚檢測。提取文獻(xiàn)數(shù)據(jù),然后用Meta-Disc(1.4)統(tǒng)計(jì)軟件進(jìn)行Meta分析,并計(jì)算合并后的診斷比值比(DOR)、合并敏感度、合并特異度、合并陽性似然比和合并陰性似然比,進(jìn)行合并受試者工作特征曲線(SROC)分析,得到合并SROC曲線下面積(AUC)。結(jié)果:共檢索出文獻(xiàn)1389篇,包括中文文獻(xiàn)934篇,英文文獻(xiàn)455篇,篩選后共有9篇文獻(xiàn)符合標(biāo)準(zhǔn),共1940例患者。入選文獻(xiàn)總體質(zhì)量較高,發(fā)表偏倚bias的t為-0.59,相應(yīng)的p值為0.571。異質(zhì)性檢驗(yàn)結(jié)果:1.敏感度對數(shù)和1-特異度對數(shù)的spearman相關(guān)系數(shù)0.017,p=0.966;2.納入研究間存在由非閾值效應(yīng)引起的異質(zhì)性,去除由非閾值效應(yīng)引起的部分異質(zhì)性,進(jìn)行回歸分析后仍未找到產(chǎn)生異質(zhì)性原因,使用隨機(jī)效應(yīng)模型合并統(tǒng)計(jì)指標(biāo)。FeNO閾值在15-25ppb之間,敏感度、特異度分別為0.74、0.70;FeNO閾值在26-35ppb之間,敏感度、特異度分別為0.60、0.86;FeNO閾值在36-45ppb之間,敏感度、特異度分別為0.80、0.80。合并后得出敏感度為74%、特異度為79%、陽性似然比值為3.63、陰性似然比值為0.29、診斷比數(shù)比的數(shù)值12.25、AUC值為0.8502。結(jié)論:1.FeNO是一種簡單、安全的氣道炎癥檢測方法,FeNO診斷哮喘的敏感度、特異性和總體診斷效能一般。在臨床上,FeNO目前仍不能替代經(jīng)典肺功能診斷哮喘地位,是較好的哮喘輔助診斷指標(biāo),應(yīng)作進(jìn)一步研究。2.FeNO值在36-45ppb之間對哮喘診斷更有指導(dǎo)意義。
[Abstract]:Objective: to evaluate the diagnostic value of exhaled nitric oxide (no) in bronchial asthma by Meta analysis. Methods: to search the database of Wanfang, Weipu, ChinaNet, (CBM) of Chinese biomedical literature database (CBM) the cochrane library Pubmedus EMBASE, and to collect the literature of FeNO related to asthma diagnosis published from January 1, 1990 to January 1, 2017. According to the diagnostic test quality evaluation-2 standard, the quality of the literature was evaluated, and the RevMan5.3 software was used to detect the risk bias of the publication. The literature data were extracted and Meta analysis was carried out with Meta-Disc (1.4) statistical software. The diagnostic ratio after the combination was calculated to be more sensitive, specific, positive and negative than that of (DOR),. The area (AUC). Under the combined SROC curve was obtained by (SROC) analysis of the combined subjects' operating characteristic curve. Results: a total of 1389 articles were retrieved, including 934 in Chinese and 455 in English. A total of 9 articles met the criteria after screening. A total of 1940 patients were selected. The overall quality of the selected literature was higher, the publication bias t was -0.59, the corresponding p value was 0.571. Heterogeneity test results: 1. The spearman correlation coefficient of the logarithm of sensitivity and the logarithm of 1-specificity was 0. 017 and 0. 966 / 2 respectively. There is heterogeneity caused by non-threshold effect and partial heterogeneity caused by non-threshold effect among the inclusion studies. After regression analysis, the cause of heterogeneity has not been found. Using the stochastic effect model to combine the statistical index. FeNO threshold between 15-25ppb, sensitivity, specificity were 0.74 ~ 0.70% Feno threshold in 26-35ppb, sensitivity, specificity were 0.60 ~ 0.86% Feno threshold in 36-45ppb, sensitivity and specificity were 0.80 ~ 0.80, respectively. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic ratio were 74, 79, 3.63, 0.29 and 0.8502, respectively. Conclusion Feno is a simple and safe method for the detection of airway inflammation. The sensitivity specificity and overall diagnostic efficacy of FeNO in the diagnosis of asthma are general. Feno is still not a substitute for classical pulmonary function in the diagnosis of asthma, and it is a better index for asthma diagnosis. 2. Feno should be studied further in the diagnosis of asthma. 2. Feno is more instructive in the diagnosis of asthma between 36-45ppb.
【學(xué)位授予單位】：川北醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R562.25

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 李楊;;磁共振胰膽管造影對肝移植性膽道并發(fā)癥診斷價(jià)值的META分析[J];臨床放射學(xué)雜志;2016年03期

2 張春喜;杜秀芳;;咳嗽變異哮喘的最新研究進(jìn)展[J];臨床肺科雜志;2016年03期

3 胡磊;查云飛;邢棟;王克軍;龔?fù)?閆立永;王嬌;林苑;;CTA對于診斷外傷性四肢動脈損傷的Meta分析[J];放射學(xué)實(shí)踐;2015年09期

4 呂福云;杜聞博;佟淑平;巴圖烏力吉;;呼出氣一氧化氮檢測及其臨床意義研究進(jìn)展[J];實(shí)用心腦肺血管病雜志;2014年12期

5 李偉棠;黃蘭卿;梁紅衛(wèi);鄧睿;鐘英豪;廖軍紅;張志萍;李世澤;;呼出氣一氧化氮檢測對支氣管哮喘患者長期管理的意義[J];中國醫(yī)藥導(dǎo)報(bào);2014年30期

6 劉霞;許文兵;劉亞男;趙陽;孟淑珍;;呼出氣一氧化氮對成人支氣管哮喘治療的指導(dǎo)作用[J];中國呼吸與危重監(jiān)護(hù)雜志;2014年02期

7 徐迎莉;馬希濤;楊志剛;;呼出氣一氧化氮檢測對支氣管哮喘的診斷意義[J];河南醫(yī)學(xué)研究;2014年01期

8 白曉雪;華樹成;竭晶;楊穎;谷月;;呼出氣一氧化氮在慢性過敏性肺炎診斷中的應(yīng)用價(jià)值[J];中國實(shí)驗(yàn)診斷學(xué);2014年01期

9 毛山;殷凱生;;支氣管哮喘患者痰中細(xì)胞因子水平的變化[J];臨床肺科雜志;2013年10期

10 鄔蘭;張永;曾憲濤;;QUADAS-2在診斷準(zhǔn)確性研究的質(zhì)量評價(jià)工具中的應(yīng)用[J];湖北醫(yī)藥學(xué)院學(xué)報(bào);2013年03期

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