Serology for the diagnosis of human hepatic cystic echinococcosis and its relation with cyst staging: A systematic review of the literature with meta-analysis.
Serology for the diagnosis of human hepatic cystic echinococcosis and its relation with cyst staging: A systematic review of the literature with meta-analysis.
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DOI：
10.1371/journal.pntd.0009370
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发表时间：
2021-04
影响因子：
3.8
通讯作者：
Siles-Lucas M
中科院分区：
文献类型：
--
作者：
Tamarozzi F;Silva R;Fittipaldo VA;Buonfrate D;Gottstein B;Siles-Lucas M
囊型棘球蚴病的诊断主要依靠影像学检查，而影像学检查不能确定诊断时，应采用血清学检查。据报道，CE囊肿分期是影响血清学诊断结果的最重要因素之一。我们对肝CE囊肿分期与血清学检测诊断灵敏度之间的关系进行了系统回顾和荟萃分析，以评估其关系是否一致，并为血清学检测结果的解释提供指导。于2019年12月1日检索了MEDLINE、EMBASE、CENTRAL和Lilacs数据库。纳入了2003年（CE囊肿分类出版年份）之后发表的原始研究，报告了血清学检测用于诊断人肝CE的灵敏度，如通过成像诊断和分期。研究质量采用Newcastle-Ottawa量表进行评估。14项研究的数据纳入荟萃分析。使用随机效应荟萃分析获得敏感性和95%置信区间的汇总估计值。总体而言，存在CE 2和CE 3（CE 3a和/或CE 3b）时检测灵敏度最高，存在CE 5和CE 4囊肿时检测灵敏度最低。ELISA、ICT和WB敏感性最高，IHA最差。我们的研究结果证实了囊肿阶段和血清学试验结果之间存在明确和一致的关系。证据的局限性包括所用抗原制剂的异质性，这妨碍了确定囊肿分期和敏感性之间的关系是否受抗原制剂类型的影响，缺乏使用不同检测试剂盒检测同一组血清的研究，以及缺乏在现场和医院环境中评估同一检测试剂盒性能的研究。我们的研究结果表明，在评估肝CE患者的血清学结果时，绝对需要考虑囊肿分期。囊状棘球蚴病是一种被忽视的人畜共患病，由中间宿主（包括人类）体内寄生虫包囊的发育引起，主要发生在肝脏。CE的诊断主要依靠影像学检查。由于CE囊肿可能呈现不同的方面（阶段），鉴别诊断的范围很广，从无害的简单囊肿到肿瘤。用于检测血清抗体的血清学测定在成像不确定时应用，但其性能取决于许多因素，其中囊肿阶段已被报道为重要的。如果这是一个强有力的发现，则绝对需要根据CE囊肿分期解释血清学结果。我们对肝CE囊肿分期与血清学检测诊断灵敏度之间关系的系统回顾和荟萃分析结果证实，这种关系是明确和一致的，并表明在评价肝CE患者的血清学结果时绝对需要考虑囊肿分期。
The diagnosis of cystic echinococcosis (CE) is primarily based on imaging, while serology should be applied when imaging is inconclusive. CE cyst stage has been reported among the most important factors influencing the outcome of serodiagnosis. We performed a systematic review and meta-analysis of the relation between cyst stage of hepatic CE and diagnostic sensitivity of serological tests, to evaluate whether their relation is a consistent finding and provide guidance for the interpretation of results of serological tests. MEDLINE, EMBASE, CENTRAL, and Lilacs databases were searched on December 1st 2019. Original studies published after 2003 (year of publication of the CE cyst classification), reporting sensitivity of serological tests applied to the diagnosis of human hepatic CE, as diagnosed and staged by imaging, were included. The quality of studies was assessed using the Newcastle-Ottawa Scale. Data from 14 studies were included in the meta-analysis. Summary estimates of sensitivities and 95% confidence intervals were obtained using random effects meta-analysis. Overall, test sensitivity was highest in the presence of CE2 and CE3 (CE3a and/or CE3b), and lowest in the presence of CE5 and CE4 cysts. ELISA, ICT and WB showed the highest sensitivities, while IHA performed worst. The results of our study confirm the presence of a clear and consistent relation between cyst stage and serological tests results. Limitations of evidence included the heterogeneity of the antigenic preparations used, which prevented to determine whether the relation between cyst stage and sensitivity was influenced by the type of antigenic preparation, the paucity of studies testing the same panel of sera with different assays, and the lack of studies assessing the performance of the same assay in both field and hospital-based settings. Our results indicate the absolute need to consider cyst staging when evaluating serological results of patients with hepatic CE. Cystic echinococcosis is a neglected zoonosis induced by the development of parasitic cysts in intermediate hosts, including humans, mostly in the liver. The diagnosis of CE is based on imaging. As CE cysts may assume different aspects (stages), the range of differential diagnoses is broad, from harmless simple cysts to neoplasms. Serological assays for the detection of serum antibodies are applied when imaging is inconclusive, but their performance depend on a number of factors, among which cyst stage has been reported as important. If this was a robust finding, it would be absolutely required to interpret serological findings in the light of CE cyst staging. The results of our systematic review and meta-analysis of the relation between cyst stage of hepatic CE and diagnostic sensitivity of serological tests confirmed that such relation is clear and consistent, and indicate the absolute need to consider cyst staging when evaluating serology results of patients with hepatic CE.
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影响因子：
11.8
作者：
Tiaoying L;Jiamin Q;Wen Y;Craig PS;Xingwang C;Ning X;Ito A;Giraudoux P;Wulamu M;Wen Y;Schantz PM
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