Liu Anlin, Chen Wushu, Wei Yining, Liang Jinkai, Liao Shuhong, Chen Yijun, Li Yongming, Wang Xidong, Chen Weisi, Qiu Ye, Li Zhengtu, Ye Feng
State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.
Nanshan School of Guangzhou Medical University, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Xi Road, Guangzhou, 510120, Guangdong, China.
BMC Pulm Med. 2023 Oct 5;23(1):374. doi: 10.1186/s12890-023-02620-3.
Hitherto, the bulk of diagnostic criteria regards Aspergillus-specific immunoglobulin E as a key item, and regard IgG as an auxiliary method in diagnose. Nevertheless, there is no conclusive study in summarize the performance of IgG and IgE diagnosing ABPA.
We conducted a systematic review to identify studies report results of IgE and IgG detection in diagnosing ABPA. QUADAS-2 tool was used to evaluate included studies, and we applied the HSROC model to calculate the pooled sensitivity and specificity. Deeks' funnel was derived to evaluated the public bias of included studies, and Cochrane Q test and I statistic were used to test the heterogeneity.
Eleven studies were included in this study (1127 subjects and 215 for IgE and IgG). Deeks's test for IgE and IgG were 0.10 and 0.19. The pooled sensitivity and specificity for IgE were 0.83 (95%CI: 0.77, 0.90) and 0.89 (0.83, 0.94), and for IgG were 0.93 (0.87, 0.97) and 0.73 (0.62,0.82), with P value < 0.001. The PLR and NLR for IgE were 7.80 (5.03,12.10) and 0.19 (0.13,0.27), while for IgG were 3.45 (2.40,4.96) and 0.09 (0.05,0.17). The combined diagnostic odds ratio and diagnostic score were 41.49 (26.74,64.36) and3.73 (3.29,4.16) for IgE, respectively, and were 38.42 (19.23,76.79) and 3.65 (2.96,4.34) for IgG.
The sensitivity for IgG diagnosing ABPA is higher than IgE, while the specificity for IgE is higher. IgG might be able to play a more important role in filtering ABPA patients.
迄今为止，大多数诊断标准将曲霉特异性免疫球蛋白E视为关键项目，而将免疫球蛋白G作为诊断的辅助方法。然而，尚无确凿研究总结免疫球蛋白G和免疫球蛋白E在诊断变应性支气管肺曲霉病（ABPA）方面的表现。
我们进行了一项系统评价，以确定报告免疫球蛋白E和免疫球蛋白G检测诊断ABPA结果的研究。使用QUADAS-2工具评估纳入研究，我们应用HSROC模型计算合并敏感性和特异性。采用Deeks漏斗图评估纳入研究的发表偏倚，并使用Cochrane Q检验和I统计量检验异质性。
本研究纳入了11项研究（1127名受试者，其中215名检测了免疫球蛋白E和免疫球蛋白G）。免疫球蛋白E和免疫球蛋白G的Deeks检验值分别为0.10和0.19。免疫球蛋白E的合并敏感性和特异性分别为0.83（95%CI：0.77，0.90）和0.89（0.83，0.94），免疫球蛋白G的合并敏感性和特异性分别为0.93（0.87，0.97）和0.73（0.62，0.82），P值<0.001。免疫球蛋白E的阳性似然比和阴性似然比分别为7.80（5.03，12.10）和0.19（0.13，0.27），免疫球蛋白G的阳性似然比和阴性似然比分别为3.45（2.40，4.96）和0.09（0.05，0.17）。免疫球蛋白E的联合诊断比值比和诊断分数分别为41.49（26.74，64.36）和3.73（3.29，4.16），免疫球蛋白G的联合诊断比值比和诊断分数分别为38.42（19.23，76.79）和3.65（2.96，4.34）。
免疫球蛋白G诊断ABPA的敏感性高于免疫球蛋白E，而免疫球蛋白E的特异性更高。免疫球蛋白G在筛选ABPA患者方面可能发挥更重要的作用。
