Zhang Yiwen, Qin Dimao, Qin Li, Yang Xiaoqian, Luo Qiang, Wang Han
Department of Cardiology, Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, 82 Qinglong St. Chengdu, Sichuan, China.
Department of Cardiology, Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, 82 Qinglong St. Chengdu, Sichuan, China.
Joint Bone Spine. 2022 Mar;89(2):105287. doi: 10.1016/j.jbspin.2021.105287. Epub 2021 Oct 1.
Pulmonary arterial hypertension (PAH) is a major cause of morbidity and mortality in systemic sclerosis (SSc). Many risk factors and predictors of outcomes have been identified in these patients. B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) serum levels are often elevated in SSc patients with early PAH. We conducted this systematic review and meta-analysis to estimate the diagnostic value of BNP/NT-proBNP in systemic sclerosis secondary pulmonary arterial hypertension (SSc-PAH).
A systematic search was performed through PubMed, Embase, and Cochrane Library databases up to January 30, 2021. Stata 16.0 (Stata Corp, College Station, TX) was used to conduct the meta-analysis.
A total of 9 studies involving 220 SSc-PAH patients and 259 non-SSc-PAH controls were included. The values of sensitivity and specificity using BNP and NT-ProBNP as diagnostic tools were pooled in the diagnostic meta-analysis. The overall performance of BNP/NT-ProBNP detection was: pooled sensitivity, 0.67 (95% CI: 0.52 to 0.79); pooled specificity, 0.84 (95% CI: 0.75 to 0.91); pooled positive likelihood ratio, 4.3 (95% CI: 3 to 6.1); and pooled negative likelihood ratio, 0.39 (95% CI: 0.28 to 0.55). The subgroup analysis showed similar results. Funnel plots indicate that there is no evidence for publication bias.
Our results revealed that NT-proBNP has certain diagnostic value for PAH due to its better specificity and moderate sensitivity, but its clinical application value remains suboptimal and can not be a stand-alone decision-making diagnostic tool of SSc-PAH.
肺动脉高压（PAH）是系统性硬化症（SSc）发病和死亡的主要原因。已在这些患者中确定了许多风险因素和预后预测指标。在患有早期PAH的SSc患者中，B型利钠肽（BNP）和N末端前脑钠肽（NT-proBNP）血清水平通常会升高。我们进行了这项系统评价和荟萃分析，以评估BNP/NT-proBNP在系统性硬化症继发肺动脉高压（SSc-PAH）中的诊断价值。
截至2021年1月30日，通过PubMed、Embase和Cochrane图书馆数据库进行了系统检索。使用Stata 16.0（Stata公司，德克萨斯州大学城）进行荟萃分析。
共纳入9项研究，涉及220例SSc-PAH患者和259例非SSc-PAH对照。在诊断性荟萃分析中汇总了使用BNP和NT-ProBNP作为诊断工具的敏感性和特异性值。BNP/NT-ProBNP检测的总体表现为：汇总敏感性为0.67（95%CI：0.52至0.79）；汇总特异性为0.84（95%CI：0.75至0.91）；汇总阳性似然比为4.3（95%CI：3至6.1）；汇总阴性似然比为0.39（95%CI：0.28至0.55）。亚组分析显示了相似的结果。漏斗图表明没有发表偏倚的证据。
我们的结果显示，NT-proBNP因其较好的特异性和中等的敏感性对PAH具有一定的诊断价值，但其临床应用价值仍不理想，不能作为SSc-PAH的独立决策诊断工具。
