Ke Yani, Zhu Yuqing, Chen Shuaihang, Hu Jie, Chen Ruilin, Li Wu, Liu Shan
The Second Clinical Medical College of Zhejiang Chinese Medical University, No 548, Binwen Road, Hangzhou, 310051, Zhejiang, China.
The First Clinical Medical College of Zhejiang Chinese Medical University, No 548, Binwen Road, Hangzhou, 310051, Zhejiang, China.
Infect Dis Ther. 2022 Oct;11(5):1981-1998. doi: 10.1007/s40121-022-00686-w. Epub 2022 Aug 25.
This study explored circulating pneumoproteins in the diagnosis, severity, and prognosis of COVID-19 by meta-analysis.
We searched five databases and other sources until December 16, 2021. Standardized mean difference (SMD) and 95% confidence interval (CI) were the overall outcomes. RevMan 5.3, Stata 16, and Meta-DiSc 1.4 were utilized for pooled analysis.
A total of 2432 subjects from 26 studies were included. Patients with COVID-19 had higher circulating KL-6, SP-D, and SP-A levels (SMD 1.34, 95% CI [0.60, 2.08]; SMD 1.74, 95% CI [0.64, 2.84]; SMD 3.42, 95% CI [1.31, 5.53], respectively) than healthy individuals. Circulating SP-D levels were not significantly different in survivors and non-survivors (SMD - 0.19, 95% CI [- 0.78, 0.40]). Circulating KL-6, SP-D, and RAGE levels in patients with mild to moderate COVID-19 were significantly lower (SMD - 0.93, 95% CI [- 1.22, - 0.65]; SMD - 1.32, 95% CI [- 2.34, - 0.29]; SMD - 1.17, 95% CI [- 2.06, - 0.28], respectively) than in patients with severe COVID-19. Subgroup analysis suggested that country and total number may be related to the heterogeneity when analyzing SP-D in patients with mild to moderate vs. severe COVID-19. The meta-analysis of diagnostic accuracy including KL-6 for severity, KL-6 for mortality, and SP-D for severity demonstrated that they all had limited diagnostic value.
Therefore, circulating pneumoproteins (KL-6, SP-D, and RAGEs) reflect the diagnosis, severity, and prognosis of COVID-19, and follow-up studies are still needed.
本研究通过荟萃分析探讨循环肺蛋白在新型冠状病毒肺炎（COVID-19）诊断、严重程度及预后中的作用。
我们检索了五个数据库及其他来源，检索截至2021年12月16日。标准化均数差（SMD）及95%置信区间（CI）为总体结局指标。采用RevMan 5.3、Stata 16及Meta-DiSc 1.4进行汇总分析。
共纳入26项研究中的2432名受试者。COVID-19患者的循环KL-6、表面活性蛋白D（SP-D）及表面活性蛋白A（SP-A）水平高于健康个体（SMD分别为1.34，95%CI[0.60，2.08]；SMD为1.74，95%CI[0.64，2.84]；SMD为3.42，95%CI[1.31，5.53]）。幸存者与非幸存者的循环SP-D水平无显著差异（SMD为-0.19，95%CI[-0.78，0.40]）。轻度至中度COVID-19患者的循环KL-6、SP-D及晚期糖基化终末产物受体（RAGE）水平显著低于重度COVID-19患者（SMD分别为-0.93，95%CI[-1.22，-0.65]；SMD为-1.32，95%CI[-2.34，-0.29]；SMD为-1.17，95%CI[-2.06，-0.28]）。亚组分析表明，在分析轻度至中度与重度COVID-19患者的SP-D时，国家及样本总量可能与异质性有关。包括用于评估严重程度的KL-6、用于评估死亡率的KL-6及用于评估严重程度的SP-D在内的诊断准确性荟萃分析表明，它们的诊断价值均有限。
因此，循环肺蛋白（KL-6、SP-D及RAGEs）可反映COVID-19的诊断、严重程度及预后，仍需进一步的随访研究。
