A Systematic Review of Diagnostic Biomarkers of COPD Exacerbation.
A Systematic Review of Diagnostic Biomarkers of COPD Exacerbation.
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DOI：
10.1371/journal.pone.0158843
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Sin DD
中科院分区：
文献类型：
--
作者：
Chen YW;Leung JM;Sin DD
本系统性综述的目的是确定哪些血液分子已被评价为诊断慢性阻塞性肺疾病（COPD）急性加重（AECOPD）的可能生物标志物，并确定这些生物标志物出版物的质量。感兴趣的患者是那些被诊断患有COPD的患者。对MEDLINE、EMBASE和CINAHL数据库进行了系统性检索，以查找截至2015年2月与AECOPD诊断生物标志物相关的出版物。我们使用了修改后的肿瘤标志物研究报告指南（mREMARK）来评估研究质量。质量的其他组成部分包括报告重复队列中的发现，以及在评估性能时使用受试者操作特征曲线下面积统计。纳入了59项研究，其中研究最多的生物标志物是C反应蛋白（CRP）、白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）。与对照受试者相比，AECOPD患者的CRP显示一致性升高，而IL-6和TNF-α具有不同的统计学显著性和结果。mREMARK评分范围为6 - 18（中位数评分为13）。12篇文章报告了ROC分析，只有一项研究采用了重复队列来确认生物标志物的性能。AECOPD诊断生物标志物的研究在报告中仍然不一致，很少有研究采用ROC分析，更少的研究证明在独立队列中重复。
The aims of this systematic review were to determine which blood-based molecules have been evaluated as possible biomarkers to diagnose chronic obstructive pulmonary disease (COPD) exacerbations (AECOPD) and to ascertain the quality of these biomarker publications. Patients of interest were those that have been diagnosed with COPD. MEDLINE, EMBASE, and CINAHL databases were searched systematically through February 2015 for publications relating to AECOPD diagnostic biomarkers. We used a modified guideline for the REporting of tumor MARKer Studies (mREMARK) to assess study quality. Additional components of quality included the reporting of findings in a replication cohort and the use of receiver-operating characteristics area-under-the curve statistics in evaluating performance. 59 studies were included, in which the most studied biomarkers were C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). CRP showed consistent elevations in AECOPD compared to control subjects, while IL-6 and TNF-α had variable statistical significance and results. mREMARK scores ranged from 6 to 18 (median score of 13). 12 articles reported ROC analyses and only one study employed a replication cohort to confirm biomarker performance. Studies of AECOPD diagnostic biomarkers remain inconsistent in their reporting, with few studies employing ROC analyses and even fewer demonstrating replication in independent cohorts.