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研究生:李治中
研究生(外文):LEE, CHIH-CHUNG
論文名稱:血清IgA對C3比值在IgA腎病中的診斷表現:系統性回顧與統合分析
論文名稱(外文):Diagnostic Performance of Serum IgA to C3 Ratio for IgA Nephropathy: A Systematic Review and Meta-Analysis
指導教授:羅爾維羅爾維引用關係
指導教授(外文):LOH, EL-WUI
口試委員:譚家偉白其卉羅爾維
口試委員(外文):TAM, KA-WAIBAI, CHYI-HUEYLOH, EL-WUI
口試日期:2024-06-12
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:臨床醫學研究所應用實證醫學碩士在職專班
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2024
畢業學年度:112
語文別:中文
論文頁數:66
中文關鍵詞:A型免疫球蛋白腎病IgA腎病血清IgA/C3比值診斷型統合分析
外文關鍵詞:IgA nephropathyserum IgA/C3 ratiodiagnostic meta-analysis
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背景:A型免疫球蛋白腎病(IgA nephropathy)盛行於亞洲人,而A型免疫球蛋白腎病的病生理機轉為腎絲球繫膜區A型免疫球蛋白沉積,導致後續發炎和損傷。儘管血清中的A型免疫球蛋白對補體C3(complement component 3)之比值與A型免疫球蛋白腎病的嚴重程度相關,但用於A型免疫球蛋白腎病的整體診斷效能仍不確定。

方法:搜索PubMed、Embase和Cochrane Library資料庫從創始至2024年4月的文獻。並使用相關檢索詞,包括(IgA或免疫球蛋白A或Berger氏病或IgA腎病)AND(C3或補體)。只要能計算出敏感度與特異度的人類研究都收納。沒有語言的限制。使用STATA套件執行統計運算及繪圖。

結果:最終收錄21個研究,共7,374名參與者,主要來自日本和中國。結果顯示,綜合敏感度為0.79(95% CI: 0.74 - 0.83),綜合特異度為0.73(95% CI: 0.68 - 0.79),綜合診斷勝算比為10.6。綜合接收者操作特徵(SROC)曲線下面積(AUC)為0.83。有統計上顯著的發表偏誤。

結論:用於A型免疫球蛋白腎病的診斷,血清IgA對C3的比值是一個有價值的工具,有機會減少不必要的腎臟切片,但仍需要更多研究進一步探討在不同族群背景下其診斷效能的表現。
Background:
IgA nephropathy (IgAN) involves the deposition of IgA in the kidneys, leading to inflammation and renal damage; this disease is particularly prevalent in Asian populations. While the serum IgA to complement component 3 (C3) ratio correlates with IgAN severity, its overall diagnostic performance remains uncertain.

Methods:
PubMed, Embase, and the Cochrane Library were searched from inception to April 2024. Various search terms were used, including (IgA or immunoglobulin A or Berger’s disease or IgA nephropathy) AND (C3 or complement). Software STATA was used for statistical analysis.

Results:
This study identified 21 studies involving 7,374 participants, from Japan and China. The meta-analysis of the IgA/C3 ratio demonstrated a pooled sensitivity of 0.79 (95% CI 0.74-0.83), a specificity of 0.73 (95% CI: 0.68-0.79), and a diagnostic odds ratio of 10.6. The area under the curve (AUC) of the Summary Receiver Operating Characteristic (SROC) curve was 0.83. Publication bias was observed.

Conclusion:
The IgA/C3 ratio is a valuable tool for IgAN diagnosis, potentially reducing unnecessary biopsies. However, further research in diverse ethnic population is needed to validate its diagnostic utility.
致謝 ii
縮寫表 iii
中文摘要 6
Abstract 7
一、緒論 8
二、材料與方法 13
1. 文獻檢索 13
2. 納入及排除條件 14
3. 資料萃取與品質評估 14
4. 數據分析 16
軟體選用及診斷型統合分析原理 16
曲線下面積(AUC) 19
異質性、迴歸分析(meta-regression) 19
敏感度分析(sensitivity analysis)、出版偏誤 20
三、結果 21
1. 搜尋結果 21
2. 收錄研究的特徵 21
3. 品質評估結果 22
4. 收錄研究的個別診斷效力 23
5. 整體統合效果 23
6. 次族群分析 24
7. 迴歸分析 25
8. 敏感度分析 25
9. 出版偏誤 26
四、討論 27
A型免疫球蛋白腎病的診斷 27
本研究成果 27
病生理機轉 28
Fagan氏圖(Fagan plot)、切點選定與臨床應用 31
異質性 35
研究限制 36
GRADE總評讀 36
五、結論與展望 39
六、參考文獻 40
七、圖表 46
圖1 搜尋過程的流程圖 46
圖2 收錄研究的整體品質(QUADAS-2) 46
圖3 收錄研究的QUADAS-2評讀細節 47
圖4 敏感度與特異度的森林圖 48
圖5 綜合診斷勝算比的森林圖 49
圖6 綜合接收者操作特徵曲線(SROC curve) 50
圖7 層次綜合接收者操作特徵曲線(HSROC curve) 51
圖8 統合迴歸(Meta-regression) 52
圖9 統合迴歸聯合模型(joint model) 53
圖9 Deeks氏漏斗圖評估不對稱性的迴歸檢驗 54
圖10 Fagan氏圖(Fagan plot) 55
表1 收錄研究的特徵 59
表2 收錄研究的相關診斷效力值 60
表3 次族群分析 61
附錄1 PRSPERO註冊碼 62
附錄2 PubMed搜尋 63
附錄3 Embase搜尋 65
附錄4 診斷勝算比與敏感度及特異度的相關性 66
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