Carroll Ty, Raff Hershel, Findling James W
Endocrinology Center, Medical College of Wisconsin, Menomonee Falls, WI 53051, USA.
Endocr Pract. 2009 May-Jun;15(4):335-42. doi: 10.4158/EP09023OR.
To report a meta-analysis of late-night salivary cortisol testing for the diagnosis of Cushing syndrome.
MEDLINE and EMBASE computer databases were searched to identify relevant articles published between January 1950 and December 2007. The search strategy used the following medical subject headings and keywords: cortisol, Cushing or Cushing's, saliva, salivary, late-night, nocturnal, and nighttime. The results were limited to studies in humans older than 18 years. Titles and abstracts of all articles, as well as full text of relevant articles, were reviewed. Sensitivity, specificity, likelihood ratio positive, likelihood ratio negative, and diagnostic odds ratio were extracted by 2 authors. Discrepancies were resolved by mediation and discussion with a third author.
Seven articles contained sufficient information to be included in the analysis. A total of 947 patients (339 with Cushing syndrome) were identified. Pooled data from the 7 studies revealed a sensitivity of 92% (95% confidence interval [CI], 88%-94%), specificity of 96% (95% CI, 94%-97%), and diagnostic odds ratio of 311 (95% CI, 92-1059). Likelihood ratio positive was 21 (95% CI, 10-43), with a likelihood ratio negative of 0.08 (95% CI, 0.02-0.32). Inconsistencies for each of these results measured by the I2 statistic ranged from moderate to high.
This analysis demonstrates that late night salivary cortisol has excellent diagnostic characteristics and as such, is a robust, convenient test for screening and diagnosis of Cushing syndrome.
报告一项关于深夜唾液皮质醇检测用于库欣综合征诊断的荟萃分析。
检索MEDLINE和EMBASE计算机数据库，以识别1950年1月至2007年12月期间发表的相关文章。检索策略使用了以下医学主题词和关键词：皮质醇、库欣或库欣氏、唾液、唾液的、深夜、夜间、夜晚。结果仅限于18岁以上人群的研究。对所有文章的标题和摘要以及相关文章的全文进行了审查。由2位作者提取敏感性、特异性、阳性似然比、阴性似然比和诊断比值比。通过与第三位作者进行调解和讨论解决分歧。
7篇文章包含足够信息可纳入分析。共识别出947例患者（339例患有库欣综合征）。7项研究的汇总数据显示敏感性为92%（95%置信区间[CI]，88%-94%），特异性为96%（95%CI，94%-97%），诊断比值比为311（95%CI，92-1059）。阳性似然比为21（95%CI，10-43），阴性似然比为0.08（95%CI，0.02-0.32）。用I2统计量衡量的这些结果中的每一个的不一致性从中度到高度不等。
该分析表明深夜唾液皮质醇具有出色的诊断特征，因此是一种用于库欣综合征筛查和诊断的可靠、便捷的检测方法。
