| Objective: To systematically evaluate the diagnostic value of exhaled nitric oxide(Fe NO)in asthma-chronic obstructive pulmonary disease(ACO).Methods: To search the common literature databases at home and abroad,such as Pubmed,Embase,Cochrane Library,How Net,Wanfang,Weipu,CBM,etc.,to find the literature related to the diagnostic value of Fe NO for ACO diseases.The published time limit of the inquired publications is set from the successful establishment of the database until January 2021.After strictly screening the literatures,the scientific quality evaluation is made for the selected literatures which can be included in this study.The tool used is QUADAS-2.After the evaluation is completed,Revman5.3 software is used to further make the entry chart of the reaction bias risk and the summary chart of the reaction bias risk.Finally,Meta-Disc1.4 software is used to carry out Meta-analysis in a standardized way.The main summary objects are Sensitivity(which can be used to measure the ability of a certain test to detect patients,which is the ratio of correctly judging actual patients as true positive,i.e.true positive rate)and Specificity(which can be used to measure the ability of a certain test to detect patients without the disease.It refers to the proportion of people who are actually not ill who are correctly judged as true negative,i.e.true negative rate),positive likelihood ratio(+LR,the ratio between true positive rate and false positive rate of diagnosis results,which reflects the possibility of correctly judging positive in a certain test and is a multiple of the possibility of wrongly judging positive),negative likelihood ratio(-LR,The ratio of false negative rate to true negative rate of diagnosis results reflects the possibility of false negative judgment in a certain test,which is a multiple of the possibility of correct negative judgment).Diagnostic Odds Ratio,(DOR,which reflects the degree of connection between diagnosis test results and diseases,is a stable comprehensive index).After that,it analyzes the sensitivity and specificity of Fe NO test for ACO diagnosis,so as to make comprehensive receiver operating characteristic curve(Symmetric receiver operating characteristic curve,SROC).Results: A total of 1,105 documents were retrieved through the initial query,and after 417 duplicate documents were excluded by using Note express3.3.0 and Endnote X7 software and manual search,688 articles remained.After further browsing the title and abstract of the articles,375 documents unrelated to this Meta-analysis were removed,and 313 articles were obtained.Finally,by reading the full text,the papers with inconsistent research contents(276 articles),unable to obtain the complete four-grid table(26 articles)and unable to obtain the Fe NO positive threshold(1 article)were excluded,and finally a total of 10 articles(including 5 articles in Chinese and5 articles in English)were obtained for this Meta-analysis.Finally,the effect model used was random,and the outcome index showed that the combined sensitivity was 0.79 [95% CI(0.75,0.83)],the specificity was 0.69 [95% CI(0.59,0.78)],and the +LR was 3.17 [95% CI(2.18,4.62)] The area under SROC curve AUC=0.85(Q*=0.7827).Because of the obvious heterogeneity of the research included in this Meta-analysis,the origin of the research was found through Meta-regression analysis,and the Fe NO positive threshold was considered,so it was further divided into two subgroups with Fe NO value of25 ppb as the boundary point,≤25ppb as group A and > 25 ppb as group B.The two groups made their own Meta-analysis,and the outcome index showed that the sensitivity of group A was 0.74[95%CI(0.68,0.79)],specificity is0.62[95%CI(0.59,0.66)],+LR is 2.06[95%CI(1.55,2.75)],-LR is0.42[95%CI(0.34,0.52)],and DOR is 0.84[95%CI(0.79,0.88)],and The area under SROC curve AUC=0.7706(Q*=0.7106)..In group B,the sensitivity,specificity,+LR and-LR were 0.87[95%CI(0.75,0.94)],0.84[95%CI(0.79,0.88)],5.13[95%CI(3.79,6.64)] and0.20[95%CI(0.16,0.26)],and DOR is 25.57[95%CI(13.86,47.16)],and The area under SROC curve AUC=0.9072(Q*=0.8391).Conclusion: The results of this study confirmed that the threshold of Fe NO measurement is 25 ppb,the combined sensitivity of Fe NO in diagnosing ACO is 87%(missed diagnosis rate is 13%),the combined specificity is 84%(misdiagnosis rate is 16%),and the AUC under SROC curve is0.9072(Q*=0.8391).It can be seen that Fe NO has excellent sensitivity and specificity in the diagnosis of ACO.from the diagnostic significance of Fe NO to ACO,it can provide a certain reference value for clinicians’ preliminary diagnosis.however,if we want to diagnose this kind of disease more clearly in practical clinical work,we still need to refer to other laboratory related examinations,specific clinical manifestations of patients and clinical research with larger sample size. |
PDF Full Text Request