唾液尿素氮用于检测成人肾脏疾病：诊断试验准确性的荟萃分析

Saliva urea nitrogen for detection of kidney disease in adults: A meta-analysis of diagnostic test accuracy.

作者信息

Kumaran Reyna, Abdalla Mona Mohamed Ibrahim, Caszo Brinnell Annette, Somanath Sushela Devi

机构信息

Human Biology Department, School of Medicine, IMU University (Formerly known as International Medical University), Kuala Lumpur, Malaysia.

Pathology Department, School of Medicine, IMU University (Formerly known as International Medical University), Kuala Lumpur, Malaysia.

出版信息

PLoS One. 2025 May 29;20(5):e0324251. doi: 10.1371/journal.pone.0324251. eCollection 2025.

DOI:10.1371/journal.pone.0324251

PMID:40440346

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12121763/

Abstract

BACKGROUND

Kidney disease affects millions globally, especially in low and middle-income countries where access to diagnostic testing is limited. Saliva urea nitrogen (SUN) has been proposed as a simple, non-invasive alternative to traditional serum-based diagnostics.

OBJECTIVE

This study aimed to evaluate the diagnostic accuracy of SUN for detecting kidney disease in adults through a systematic review and meta-analysis.

METHODS

This review adhered to the PRISMA-DTA guidelines. A comprehensive search of five databases was conducted without language or date restrictions. Study quality was assessed using the QUADAS-2 tool. STATA version 17 was used for analysis. A random-effects model was used to estimate pooled sensitivity, specificity, and diagnostic odds ratios (DOR). Subgroup analysis was conducted based on the reference test used (serum creatinine or blood urea nitrogen). Heterogeneity was assessed using the I² statistic, and meta-regression explored sources of heterogeneity.

RESULTS

Seven studies (n = 1,933) met the inclusion criteria. In the serum creatinine (sCr) subgroup (2 studies), SUN showed pooled sensitivity of 0.44 (95% CI: 0.38-0.49), specificity 0.96 (95% CI: 0.95-0.98), DOR 18.89 (95% CI: 15.19-23.57), and AUC ~ 0.90. In the blood urea nitrogen (BUN) subgroup (5 studies), sensitivity was 0.83 (95% CI: 0.69-0.91), specificity 0.88 (95% CI: 0.78-0.94), DOR 37 (95% CI: 15-91), and AUC 0.93. Heterogeneity was moderate in the BUN subgroup (bivariate I² = 51%), with 42% of variability attributed to threshold effects. Meta-regression identified study country (p = 0.01), and reference test used (p = 0.02) as contributors to heterogeneity in sensitivity, while comorbidity (p = 0.001) significantly affected specificity.

CONCLUSION

SUN shows high diagnostic specificity and a good overall accuracy, particularly when compared to BUN, and may serve as a practical non-invasive screening tool in low- resource settings. While heterogeneity was present, SUN remains a promising diagnostic alternative and warrants further validation in diverse clinical populations.

摘要

背景

肾病在全球影响着数百万人，尤其是在中低收入国家，那里获得诊断检测的机会有限。唾液尿素氮（SUN）已被提议作为一种简单、非侵入性的传统血清诊断替代方法。

目的

本研究旨在通过系统评价和荟萃分析评估SUN检测成人肾病的诊断准确性。

方法

本评价遵循PRISMA-DTA指南。对五个数据库进行了全面检索，无语言或日期限制。使用QUADAS-2工具评估研究质量。使用STATA 17版进行分析。采用随机效应模型估计合并敏感性、特异性和诊断比值比（DOR）。根据所使用的参考测试（血清肌酐或血尿素氮）进行亚组分析。使用I²统计量评估异质性，并进行Meta回归以探索异质性来源。

结果

七项研究（n = 1,933）符合纳入标准。在血清肌酐（sCr）亚组（2项研究）中，SUN显示合并敏感性为0.44（95%CI：0.38 - 0.49），特异性为0.96（95%CI：0.95 - 0.98），DOR为18.89（95%CI：15.19 - 23.57），AUC约为0.90。在血尿素氮（BUN）亚组（5项研究）中，敏感性为0.83（95%CI：0.69 - 0.91），特异性为0.88（95%CI：0.78 - 0.94），DOR为37（95%CI：15 - 91），AUC为0.93。BUN亚组的异质性为中度（双变量I² = 51%），42%的变异性归因于阈值效应。Meta回归确定研究国家（p = 0.01）和所使用的参考测试（p = 0.02）是敏感性异质性的影响因素，而合并症（p = 0.001）显著影响特异性。