胎儿纤连蛋白作为有症状患者早产的短期预测指标：一项荟萃分析。
Fetal fibronectin as a short-term predictor of preterm birth in symptomatic patients: a meta-analysis.
作者信息
Sanchez-Ramos Luis, Delke Isaac, Zamora Javier, Kaunitz Andrew M
机构信息
From the Department of Obstetrics & Gynecology, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida; the Clinical Biostatistics Unit, Ramon y Cajal Hospital, Madrid, Spain; and CIBER Epidemiología y Salud Püblica (CIBERESP), Barcelona, Spain.
出版信息
Obstet Gynecol. 2009 Sep;114(3):631-640. doi: 10.1097/AOG.0b013e3181b47217.
OBJECTIVE
To appraise critically the diagnostic accuracy of cervicovaginal fetal fibronectin as a short-term predictor of preterm birth in patients with signs and symptoms of preterm labor.
DATA SOURCES
We searched MEDLINE, Current Contents, Index Medicus, EMBASE, the Cochrane Library, and syllabi from scientific meetings, and we performed manual searches of references from textbooks and of known primary and systematic review articles. We also contacted authors, experts on this subject, and the manufacturer.
METHODS OF STUDY SELECTION
We targeted cohort studies reporting data on the diagnostic accuracy of fetal fibronectin for the prediction of preterm birth within 7 days in symptomatic patients before 37 weeks of gestation. Case-control studies were excluded. The total analysis included 32 trials with 5,355 overall participants.
TABULATION, INTEGRATION, AND RESULTS: Two authors independently assessed methodological quality and constructed 2x2 tables for assessment of diagnostic measures. Pooled estimates of sensitivity, specificity, and likelihood ratios were obtained using a bivariate random effects model. Tests for publication bias and meta-regression were performed. Sensitivity analyses were performed for studies using different fetal fibronectin assays. The overall pooled estimates for sensitivity and specificity were 76.1% (95% confidence interval [CI] 69.1-81.9) and 81.9% (95% CI 78.9-84.5), respectively. Likelihood ratios for a positive and negative fetal fibronectin test were 4.20 (95% CI 3.53-4.99) and 0.29 (95% CI 0.22-0.38), respectively. Meta-regression analyses found that test accuracy was affected by prevalence, publication year, and blinding of studies. When subgroup analyses were performed for studies using the same assay, the results were similar.
CONCLUSION
The cervicovaginal fetal fibronectin assay has limited accuracy in predicting preterm birth within 7 days of sampling in symptomatic pregnant women.
目的
严格评估宫颈阴道胎儿纤连蛋白作为早产征兆和症状患者早产短期预测指标的诊断准确性。
资料来源
我们检索了MEDLINE、《现刊目次》、《医学索引》、EMBASE、Cochrane图书馆以及科学会议的教学大纲，并对手册、教科书参考文献以及已知的原始和系统评价文章进行了手工检索。我们还联系了作者、该领域的专家以及制造商。
研究选择方法
我们的目标是队列研究，这些研究报告了在妊娠37周前有症状的患者中，胎儿纤连蛋白对7天内早产预测的诊断准确性数据。排除病例对照研究。总体分析包括32项试验，共有5355名参与者。
列表、整合与结果：两位作者独立评估方法学质量，并构建2×2表格以评估诊断指标。使用双变量随机效应模型获得敏感性、特异性和似然比的合并估计值。进行发表偏倚检验和meta回归分析。对使用不同胎儿纤连蛋白检测方法的研究进行敏感性分析。敏感性和特异性的总体合并估计值分别为76.1%（95%置信区间[CI]69.1 - 81.9）和81.9%（95%CI 78.9 - 84.5）。胎儿纤连蛋白检测呈阳性和阴性的似然比分别为4.20（95%CI 3.53 - 4.99）和0.29（95%CI 0.22 - 0.38）。Meta回归分析发现，检测准确性受研究的患病率、发表年份和盲法影响。当对使用相同检测方法的研究进行亚组分析时，结果相似。
结论
宫颈阴道胎儿纤连蛋白检测在有症状的孕妇中，对采样后7天内早产的预测准确性有限。
Zotero 插件