呼出气一氧化氮检测对于疑似哮喘患者的诊断准确性：一项系统回顾和Meta分析
2018/01/08
摘要
目的：评估呼出气一氧化氮（FeNO）检测在疑似哮喘患者中的诊断准确性。
方法：从2017年4月4日起通过检索MEDLINE，EMBASE，PsycINFO，Cochrane和SciVerse 中评估FeNO对于年龄不小于5岁的疑似哮喘的患者诊断的准确性的研究。 独立审稿人选择研究并提取数据。 我们使用对称分层汇总接收机操作特性模型来估计测试性能。
结果： 我们纳入了43项研究，总共13,747名患者。 在成年人中， FeNO界值分别定为＜20,20-29,30-39和≥40ppb时，对于哮喘诊断的敏感度分别为0.80,0.69,0.53和0.41，特异度分别为0.64,0.78， 0.85和0.93。 在儿童疑似患者中，FeNO界值定为＜20和20-29ppb时，对于哮喘诊断的敏感度分别为0.78和0.61，特异度分别为0.79和0.89。 根据FeNO界值的不同，检验的阳性结果对于哮喘诊断的阳性预测率可增加2.80倍至7.00倍不等。 FeNO对于未使用过激素的哮喘患者、儿童患者及非吸烟的哮喘患者诊断准确性相对较高。
结论：呼出气一氧化氮测量对于诊断5岁及以上个体中的哮喘具有良好的准确度。对于未使用过激素的哮喘患者、儿童患者及非吸烟的哮喘患者诊断准确性较一般疑似哮喘患者更好
The Diagnostic Accuracy of Fractional Exhaled Nitric Oxide Testing in Asthma: A Systematic Review and Meta-analyses
Wang Z, Pianosi PT, Keogh KA, Zaiem F, Alsawas M, Alahdab F, Almasri J, Mohammed K, Larrea-Mantilla L, Farah W, Daraz L, Barrionuevo P, Morrow AS, Prokop LJ, Murad MH.
Abstract
OBJECTIVE:To evaluate the diagnostic accuracy of fractional exhaled nitric oxide (FeNO) measurement in individuals with suspected asthma.
METHODS:We searched MEDLINE, EMBASE, PsycINFO, Cochrane databases, and SciVerse Scopus from the databases' inception through April 4, 2017, for studies that enrolled patients aged 5 years and older with suspected asthma and evaluated FeNO diagnostic accuracy. Independent reviewers selected studies and extracted data. We used the symmetric hierarchical summary receiver operating characteristic models to estimate test performance.
RESULTS:We included 43 studies with a total of 13,747 patients. In adults, using FeNO cutoffs of less than 20, 20 to 29, 30 to 39, and 40 or more parts per billion, FeNO testing had sensitivities of 0.80, 0.69, 0.53, and 0.41, respectively, and specificities of 0.64, 0.78, 0.85, and 0.93, respectively. In children, using FeNO cutoffs of less than 20 and 20 to 29 parts per billion, FeNO testing had sensitivities of 0.78 and 0.61, respectively, and specificities of 0.79 and 0.89, respectively. Depending on the FeNO cutoff, the posttest odds of having asthma with a positive FeNO test result increased by 2.80- to 7.00-fold. Diagnostic accuracy was modestly better in corticosteroid-naive asthmatics, children, and nonsmokers than in the overall population.
CONCLUSIONS:Fractional exhaled nitric oxide measurement has moderate accuracy to diagnose asthma in individuals aged 5 years and older. Test performance may be modestly better in corticosteroid-naive asthmatics, children, and nonsmokers than in the general population with suspected asthma.
目的：评估呼出气一氧化氮（FeNO）检测在疑似哮喘患者中的诊断准确性。
方法：从2017年4月4日起通过检索MEDLINE，EMBASE，PsycINFO，Cochrane和SciVerse 中评估FeNO对于年龄不小于5岁的疑似哮喘的患者诊断的准确性的研究。 独立审稿人选择研究并提取数据。 我们使用对称分层汇总接收机操作特性模型来估计测试性能。
结果： 我们纳入了43项研究，总共13,747名患者。 在成年人中， FeNO界值分别定为＜20,20-29,30-39和≥40ppb时，对于哮喘诊断的敏感度分别为0.80,0.69,0.53和0.41，特异度分别为0.64,0.78， 0.85和0.93。 在儿童疑似患者中，FeNO界值定为＜20和20-29ppb时，对于哮喘诊断的敏感度分别为0.78和0.61，特异度分别为0.79和0.89。 根据FeNO界值的不同，检验的阳性结果对于哮喘诊断的阳性预测率可增加2.80倍至7.00倍不等。 FeNO对于未使用过激素的哮喘患者、儿童患者及非吸烟的哮喘患者诊断准确性相对较高。
结论：呼出气一氧化氮测量对于诊断5岁及以上个体中的哮喘具有良好的准确度。对于未使用过激素的哮喘患者、儿童患者及非吸烟的哮喘患者诊断准确性较一般疑似哮喘患者更好
(中日友好医院呼吸与危重症医学科 张科文 摘译 林江涛 审校)
(Mayo Clin Proc. 2017 Dec 16. pii: S0025-6196(17)30831-5.)
(Mayo Clin Proc. 2017 Dec 16. pii: S0025-6196(17)30831-5.)
The Diagnostic Accuracy of Fractional Exhaled Nitric Oxide Testing in Asthma: A Systematic Review and Meta-analyses
Wang Z, Pianosi PT, Keogh KA, Zaiem F, Alsawas M, Alahdab F, Almasri J, Mohammed K, Larrea-Mantilla L, Farah W, Daraz L, Barrionuevo P, Morrow AS, Prokop LJ, Murad MH.
Abstract
OBJECTIVE:To evaluate the diagnostic accuracy of fractional exhaled nitric oxide (FeNO) measurement in individuals with suspected asthma.
METHODS:We searched MEDLINE, EMBASE, PsycINFO, Cochrane databases, and SciVerse Scopus from the databases' inception through April 4, 2017, for studies that enrolled patients aged 5 years and older with suspected asthma and evaluated FeNO diagnostic accuracy. Independent reviewers selected studies and extracted data. We used the symmetric hierarchical summary receiver operating characteristic models to estimate test performance.
RESULTS:We included 43 studies with a total of 13,747 patients. In adults, using FeNO cutoffs of less than 20, 20 to 29, 30 to 39, and 40 or more parts per billion, FeNO testing had sensitivities of 0.80, 0.69, 0.53, and 0.41, respectively, and specificities of 0.64, 0.78, 0.85, and 0.93, respectively. In children, using FeNO cutoffs of less than 20 and 20 to 29 parts per billion, FeNO testing had sensitivities of 0.78 and 0.61, respectively, and specificities of 0.79 and 0.89, respectively. Depending on the FeNO cutoff, the posttest odds of having asthma with a positive FeNO test result increased by 2.80- to 7.00-fold. Diagnostic accuracy was modestly better in corticosteroid-naive asthmatics, children, and nonsmokers than in the overall population.
CONCLUSIONS:Fractional exhaled nitric oxide measurement has moderate accuracy to diagnose asthma in individuals aged 5 years and older. Test performance may be modestly better in corticosteroid-naive asthmatics, children, and nonsmokers than in the general population with suspected asthma.
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