评估目前生物标志物在射血分数保留的心力衰竭中的诊断准确性：系统评价和荟萃分析。
Evaluation of the diagnostic accuracy of current biomarkers in heart failure with preserved ejection fraction: A systematic review and meta-analysis.
机构信息
School of Life Sciences, Faculty of Science, University of Technology Sydney, PO Box 123 Broadway, 2007 NSW, Australia; Inflammation Group, Heart Research Institute, University of Sydney, 2006 NSW, Australia.
School of Life Sciences, Faculty of Science, University of Technology Sydney, PO Box 123 Broadway, 2007 NSW, Australia.
出版信息
Arch Cardiovasc Dis. 2021 Dec;114(12):793-804. doi: 10.1016/j.acvd.2021.10.007. Epub 2021 Nov 19.
BACKGROUND
A number of circulating biomarkers are currently utilized for the diagnosis of chronic heart failure with preserved ejection fraction (HFpEF). However, due to HFpEF heterogeneity, the accuracy of these biomarkers remains unclear.
AIMS
This study aimed to systematically determine the diagnostic accuracy of currently available biomarkers for chronic HFpEF.
METHODS
PubMed, Web of Science, MEDLINE and SCOPUS databases were searched systematically to identify studies assessing the diagnostic accuracy of biomarkers of chronic HFpEF with left ventricular ejection fraction (LVEF) ≥50%. All included studies were independently assessed for quality and relevant information was extracted. Random-effects models were used to estimate the pooled diagnostic accuracy of HFpEF biomarkers.
RESULTS
The search identified 6145 studies, of which 19 were included. Four biomarkers were available for meta-analysis. The pooled sensitivity of B-type natriuretic peptide (BNP) (0.787, 95% confidence interval [CI] 0.719-0.842) was higher than that of N-terminal pro-BNP (NT-proBNP) (0.696, 95% CI 0.599-0.779) in chronic HFpEF diagnosis. However, NT-proBNP showed improved specificity (0.882, 95% CI 0.778-0.941) compared to BNP (\0.796, 95% CI 0.672-0.882). Galectin-3 (Gal-3) exhibited a reliable diagnostic adequacy for HFpEF (sensitivity 0.760, 95% CI 0.631-0.855; specificity 0.803, 95% CI 0.667-0.893). However, suppression of tumorigenesis-2 (ST2) displayed limited diagnostic performance for chronic HFpEF diagnosis (sensitivity 0.636, 95% CI 0.465-0.779; specificity 0.595, 95% CI 0.427-0.743).
CONCLUSION
NT-proBNP and BNP appear to be the most reliable biomarkers in chronic HFpEF with NT-proBNP showing higher specificity and BNP showing higher sensitivity. Although Gal-3 appears more reliable than ST2 in HFpEF diagnosis, the conclusions are limited as only three studies were included in this meta-analysis.
背景
目前有许多循环生物标志物可用于诊断射血分数保留的慢性心力衰竭（HFpEF）。然而，由于 HFpEF 异质性，这些生物标志物的准确性仍不清楚。
目的
本研究旨在系统确定目前用于诊断慢性 HFpEF 的生物标志物的诊断准确性。
方法
系统检索 PubMed、Web of Science、MEDLINE 和 SCOPUS 数据库，以确定评估左心室射血分数（LVEF）≥50%的慢性 HFpEF 生物标志物诊断准确性的研究。所有纳入的研究均独立进行质量评估，并提取相关信息。使用随机效应模型估计 HFpEF 生物标志物的汇总诊断准确性。
结果
搜索共确定了 6145 项研究，其中 19 项研究被纳入。有 4 种生物标志物可进行荟萃分析。B 型利钠肽（BNP）的汇总敏感性（0.787，95%置信区间[CI] 0.719-0.842）高于氨基末端 B 型利钠肽前体（NT-proBNP）（0.696，95%CI 0.599-0.779）。然而，与 BNP（\0.796，95%CI 0.672-0.882）相比，NT-proBNP 显示出更高的特异性（0.882，95%CI 0.778-0.941）。半乳糖凝集素-3（Gal-3）对 HFpEF 的诊断具有可靠的诊断效能（敏感性 0.760，95%CI 0.631-0.855；特异性 0.803，95%CI 0.667-0.893）。然而，肿瘤抑制因子-2（ST2）对慢性 HFpEF 的诊断表现出有限的诊断性能（敏感性 0.636，95%CI 0.465-0.779；特异性 0.595，95%CI 0.427-0.743）。
结论
NT-proBNP 和 BNP 似乎是慢性 HFpEF 最可靠的生物标志物，其中 NT-proBNP 特异性更高，BNP 敏感性更高。虽然 Gal-3 在 HFpEF 诊断中似乎比 ST2 更可靠，但由于本次荟萃分析仅纳入了三项研究，因此结论有限。
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