suPAR 在慢性阻塞性肺疾病患者诊断和预测中的临床价值：系统评价和荟萃分析。
The clinical value of suPAR in diagnosis and prediction for patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis.
机构信息
Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China.
The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China.
出版信息
Ther Adv Respir Dis. 2020 Jan-Dec;14:1753466620938546. doi: 10.1177/1753466620938546.
BACKGROUND
Soluble urokinase-type plasminogen activator receptor (suPAR) is positively correlated with immune system activity. Inflammation can promote the development of chronic obstructive pulmonary disease (COPD). Therefore, this study conducted a systematic review and meta-analysis to assess the association between suPAR levels and the pathogenesis of COPD, and further assess the exact clinical value of suPAR in COPD.
METHODS
PubMed, Excerpt Medica Database (Embase), Web of Science (WOS), and Cochrane Library databases were searched for studies that reported the value of suPAR diagnosis for adult COPD patients.
RESULTS
A total of 11 studies were included, involving 4520 participants. Both COPD patients with predicted forced expiratory volume in 1 s (FEV1)⩾80% [weighted mean difference (WMD) = 320.25; 95% confidence interval (CI): 99.79-540.71] and FEV1 < 80% (WMD = 2950.74; 95% CI: 2647.06-3254.43) showed higher suPAR level. The sensitivity and specificity of suPAR for diagnosis of COPD were 87% and 79%, respectively, and AUC was 84%. This can not only effectively identify acute exacerbation of COPD (AECOPD) in a healthy population (WMD = 3114.77; 95% CI: 2814.66-3414.88), but also has the potential to distinguish AECOPD from stable COPD (WMD = 351.40; 95% CI: 215.88-486.93). There was a significant decrease of suPAR level after treatment [WMD = -1226.97; 95% CI: -1380.91- (-1073.03)].
CONCLUSION
suPAR as a novel biomarker has potential for early diagnosis of COPD and prediction of AECOPD. There is a potential correlation between the level of suPAR and the state of COPD, which may also indicate the early state and severity of COPD. When the suPAR level of COPD patients is further increased, the risk of acute exacerbation increases and should be highly valued. This also shows potential as a measure of treatment response, and as a guide to the clinical management in COPD.
背景
可溶性尿激酶型纤溶酶原激活物受体（suPAR）与免疫系统活性呈正相关。炎症可促进慢性阻塞性肺疾病（COPD）的发展。因此，本研究进行了系统评价和荟萃分析，以评估 suPAR 水平与 COPD 发病机制的关系，并进一步评估 suPAR 在 COPD 中的确切临床价值。
方法
检索了PubMed、Excerpt Medica Database（Embase）、Web of Science（WOS）和 Cochrane Library 数据库，以评估 suPAR 对成人 COPD 患者的诊断价值。
结果
共纳入 11 项研究，涉及 4520 名参与者。无论是预计用力呼气量 1 秒率（FEV1）≥80%的 COPD 患者[加权均数差（WMD）=320.25；95%置信区间（CI）：99.79-540.71]还是 FEV1<80%的 COPD 患者（WMD=2950.74；95%CI：2647.06-3254.43），suPAR 水平均较高。suPAR 对 COPD 的诊断灵敏度和特异度分别为 87%和 79%，AUC 为 84%。它不仅可以有效识别健康人群中的 COPD 急性加重（AECOPD）（WMD=3114.77；95%CI：2814.66-3414.88），而且还具有区分 AECOPD 与稳定期 COPD 的潜力（WMD=351.40；95%CI：215.88-486.93）。治疗后 suPAR 水平显著下降[WMD=-1226.97；95%CI：-1380.91-（-1073.03）]。
结论
suPAR 作为一种新型生物标志物，具有 COPD 早期诊断和预测 AECOPD 的潜力。suPAR 水平与 COPD 状态之间存在潜在相关性，这也可能表明 COPD 的早期状态和严重程度。当 COPD 患者的 suPAR 水平进一步升高时，急性加重的风险增加，应引起高度重视。这也显示了其作为治疗反应评估指标的潜力，以及作为 COPD 临床管理的指导。
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