Wang Chuanzhu, Wang Qingbao, Liu Tong, Zhu Jun, Zhang Boke
Department of Clinical Laboratory, Anhui No. 2 Provincial People's Hospital, Hefei, PR China.
Department of Clinical Laboratory Center, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, PR China.
Clin Biochem. 2023 Apr;114:30-38. doi: 10.1016/j.clinbiochem.2023.01.010. Epub 2023 Jan 24.
Pulmonary fibrosis (PF) is a respiratory disease with end-stage pathological changes of interstitial lung disease that severely affects the survival of patients. Among the many biomarkers that have been identified, serum Krebs von den Lungen-6 (KL-6) is by far the most frequent marker for detecting pulmonary fibrosis.
We searched Medline (Pubmed), Embase, Web of science, and Cochrane databases for articles published between inception and August 2022 in order to explore the association between KL-6 and pulmonary fibrosis. Characteristics of patients and studies included in the articles were extracted by two independent investigators according to the inclusion and exclusion criteria. We reflected the accuracy of KL-6 in distinguishing between PF and non-PF by calculating sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and area under the curve by SROC curves. The presence of heterogeneity was reflected by I in the forest plot, and then the source of heterogeneity was investigated by meta-regression.
We searched for 939 research papers, of which 16 met the inclusion criteria. Meta-analysis showed a sensitivity of 0.87 (95 % CI: 0.78-0.92), specificity of 0.91 (95 % CI: 0.86-0.95), positive likelihood ratio of 10.2 (95 % CI: 6.1, 17.0) and negative likelihood ratio of 0.14 (95 % CI: 0.08, 0.25) for KL-6 in diagnosing pulmonary fibrosis. The area under the receiver operating characteristic curve was 0.95 (95 % CI: 0.93-0.97). The results showed significant heterogeneity in both sensitivity and specificity (I = 94.55 and 91.52, respectively). Meta-regression analysis identified race as the cause of sensitivity heterogeneity and assay methodology as the cause of specificity heterogeneity.
The analysis of this study suggests that serum KL-6 is a better tool for the diagnosis of pulmonary fibrosis when factors such as disease cause and control group category are not specifically considered.
肺纤维化(PF)是一种间质性肺疾病终末期病理改变的呼吸系统疾病,严重影响患者生存。在已确定的众多生物标志物中,血清克雷伯斯-冯-登-龙根-6(KL-6)是目前检测肺纤维化最常用的标志物。
我们检索了Medline(Pubmed)、Embase、科学网和考克兰数据库中自数据库建立至2022年8月发表的文章,以探讨KL-6与肺纤维化之间的关联。两名独立研究人员根据纳入和排除标准提取文章中纳入的患者和研究的特征。我们通过计算敏感性、特异性、阳性似然比、阴性似然比以及SROC曲线下面积,来反映KL-6在区分PF和非PF方面的准确性。森林图中的I反映了异质性的存在,然后通过Meta回归研究异质性的来源。
我们检索到939篇研究论文,其中16篇符合纳入标准。Meta分析显示,KL-6诊断肺纤维化的敏感性为0.87(95%CI:0.78-0.92),特异性为0.91(95%CI:0.86-0.95),阳性似然比为10.2(95%CI:6.1,17.0),阴性似然比为0.14(95%CI:0.08,0.25)。受试者工作特征曲线下面积为0.95(95%CI:0.93-0.97)。结果显示敏感性和特异性均存在显著异质性(I分别为94.55和91.52)。Meta回归分析确定种族是敏感性异质性的原因,检测方法是特异性异质性的原因。
本研究分析表明,在未特别考虑疾病病因和对照组类别等因素时,血清KL-6是诊断肺纤维化的较好工具。