Accuracy of urea breath test in Helicobacter pylori infection: Meta-analysis
Accuracy of urea breath test in Helicobacter pylori infection: Meta-analysis
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DOI：
10.3748/wjg.v21.i4.1305
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发表时间：
2015-01-28
影响因子：
4.3
通讯作者：
Knawy, Bandar
中科院分区：
文献类型：
--
作者：
Ferwana, Mazen;Abdulmajeed, Imad;Knawy, Bandar
目的：定量总结和评价尿素呼气试验(UBT)用于诊断消化不良患者幽门螺杆菌(Hp)感染的现有证据，并提供综合诊断准确性措施。方法：检索MEDLINE、EMBASE、Cochrane图书馆等数据库，探讨UBT对Hp感染的诊断价值。我们纳入了评估UBT在有消化不良症状的成人患者中诊断准确性的横断面研究。使用QUADAS(诊断准确性研究的质量评估)-2工具评估偏倚风险。使用随机效应模型合并诊断准确度测量。亚群分析按UBT型(C-13与C-14)和测量技术(红外光谱与同位素比质谱仪)进行。结果：在1380项研究中，只有23项符合资格标准。14项研究(61%)评估了C-13UBT，9项研究(39%)评估了C-14UBT。在不同研究中使用的参考标准测试的类型有很大差异。合并灵敏度为0.96(95%CI：0.95~0.97)，合并特异度为0.93(95%CI：0.91~0.94)。阳性试验的似然比为12，阴性试验的似然比为0.05%，曲线下面积为0.985。Meta分析与亚组分析后仍未解释的显著统计学异质性有关。结论：UBT对消化不良患者幽门螺杆菌感染的诊断具有较高的准确性。然而，诊断性荟萃分析估计的可靠性受到显著异质性的限制。
AIM: To quantitatively summarize and appraise the available evidence of urea breath test (UBT) use to diagnose Helicobacter pylori (H. pylori) infection in patients with dyspepsia and provide pooled diagnostic accuracy measures.METHODS: We searched MEDLINE, EMBASE, Cochrane library and other databases for studies addressing the value of UBT in the diagnosis of H. pylori infection. We included cross-sectional studies that evaluated the diagnostic accuracy of UBT in adult patients with dyspeptic symptoms. Risk of bias was assessed using QUADAS (Quality Assessment of Diagnostic Accuracy Studies)-2 tool. Diagnostic accuracy measures were pooled using the random-effects model. Subgroup analysis was conducted by UBT type (C-13 vs C-14) and by measurement technique (Infrared spectrometry vs Isotope Ratio Mass Spectrometry).RESULTS: Out of 1380 studies identified, only 23 met the eligibility criteria. Fourteen studies (61%) evaluated C-13 UBT and 9 studies (39%) evaluated C-14 UBT. There was significant variation in the type of reference standard tests used across studies. Pooled sensitivity was 0.96 (95%CI: 0.95-0.97) and pooled specificity was 0.93 (95%CI: 0.91-0.94). Likelihood ratio for a positive test was 12 and for a negative test was 0.05 with an area under thecurve of 0.985. Meta-analyses were associated with a significant statistical heterogeneity that remained unexplained after subgroup analysis. The included studies had a moderate risk of bias.CONCLUSION: UBT has high diagnostic accuracy for detecting H. pylori infection in patients with dyspepsia. The reliability of diagnostic meta-analytic estimates however is limited by significant heterogeneity.