The accuracy of diagnostic indicators for coeliac disease: A systematic review and meta-analysis.
The accuracy of diagnostic indicators for coeliac disease: A systematic review and meta-analysis.
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DOI：
10.1371/journal.pone.0258501
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Whiting P
中科院分区：
文献类型：
--
作者：
Elwenspoek MMC;Jackson J;O'Donnell R;Sinobas A;Dawson S;Everitt H;Gillett P;Hay AD;Lane DL;Mallett S;Robins G;Watson JC;Jones HE;Whiting P
乳糜泻 (CD) 的患病率约为 1%，但诊断因不同的表现和非特异性症状和体征而受到挑战。本研究旨在确定诊断指标，以帮助识别患有 CD 风险较高且需要进一步检测的患者。遵循系统评价方法的国际指南，并在 PROSPERO 上注册了该评价（CRD42020170766）。截至 2021 年 4 月，对六个数据库进行了检索。调查患有和未患有 CD 的人的诊断指标（例如症状或风险状况）的研究符合纳入条件。使用 QUADAS-2 工具评估偏倚风险。通过拟合双变量随机效应荟萃分析来估计每个诊断指标的敏感性、特异性和阳性预测值。荟萃分析中纳入了 191 项报告 26 项诊断指标的研究。我们发现研究之间的诊断准确性估计存在很大差异，并且大多数研究存在很高的偏倚风险。我们发现强有力的证据表明，患有疱疹样皮炎、偏头痛、CD家族史、HLA DQ2/8风险基因型、贫血、1型糖尿病、骨质疏松症或慢性肝病的人比一般人群更有可能患有CD。症状，牛皮癣、癫痫、炎症性肠病、系统性红斑狼疮、骨折、2型糖尿病和多发性硬化症的诊断能力较差。敏感性分析显示，CD 患者的一级亲属患 CD 的风险高出 3 倍。对患有疱疹样皮炎、偏头痛、CD家族史、HLA DQ2/8风险基因型、贫血、1型糖尿病、骨质疏松症或慢性肝病的个体进行有针对性的检测可以改善CD病例的发现，从而加快适当的治疗并减少不良后果。偏头痛和慢性肝病尚未被列为所有 CD 指南中的危险因素，但添加这些可能是适当的。未来的研究应该建立组合指标的诊断价值。
The prevalence of coeliac disease (CD) is around 1%, but diagnosis is challenged by varied presentation and non-specific symptoms and signs. This study aimed to identify diagnostic indicators that may help identify patients at a higher risk of CD in whom further testing is warranted. International guidance for systematic review methods were followed and the review was registered at PROSPERO (CRD42020170766). Six databases were searched until April 2021. Studies investigating diagnostic indicators, such as symptoms or risk conditions, in people with and without CD were eligible for inclusion. Risk of bias was assessed using the QUADAS-2 tool. Summary sensitivity, specificity, and positive predictive values were estimated for each diagnostic indicator by fitting bivariate random effects meta-analyses. 191 studies reporting on 26 diagnostic indicators were included in the meta-analyses. We found large variation in diagnostic accuracy estimates between studies and most studies were at high risk of bias. We found strong evidence that people with dermatitis herpetiformis, migraine, family history of CD, HLA DQ2/8 risk genotype, anaemia, type 1 diabetes, osteoporosis, or chronic liver disease are more likely than the general population to have CD. Symptoms, psoriasis, epilepsy, inflammatory bowel disease, systemic lupus erythematosus, fractures, type 2 diabetes, and multiple sclerosis showed poor diagnostic ability. A sensitivity analysis revealed a 3-fold higher risk of CD in first-degree relatives of CD patients. Targeted testing of individuals with dermatitis herpetiformis, migraine, family history of CD, HLA DQ2/8 risk genotype, anaemia, type 1 diabetes, osteoporosis, or chronic liver disease could improve case-finding for CD, therefore expediting appropriate treatment and reducing adverse consequences. Migraine and chronic liver disease are not yet included as a risk factor in all CD guidelines, but it may be appropriate for these to be added. Future research should establish the diagnostic value of combining indicators.
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3.7
作者：
Ludvigsson, Jonas F.;Murray, Joseph A.
通讯作者：
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影响因子：
24.5
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12.6
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Murray, Joseph A.
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