C反应蛋白在冠心病诊断中的价值与文献评价.docVIP

C反应蛋白在冠心病诊断中的价值与文献评价 　　作者：陈志晓，杨凤爱，张辉荣,伍绍东 作者单位：阳江市人民医院，广东 阳江 529500;阳江市中西医结合医院，广东 阳江 529500;中山大学附属第五医院，广东 珠海 519000 　　【摘要】目的：从循证医学的角度对C反应蛋白诊断冠心病价值作文献评价。方法：参照诊断性试验的评价指标对文献的设计方案、研究对象的选择、参考值的确立、诊断试验的评价指标等进行评价。结果：在纳入的65篇文献中49篇说明了研究对象的来源;27篇与金标准进行了比较;只有1篇提及盲法，没有文章说明临界值的确定，没有文章说明诊断性指标(敏感度、特异度、似然比等)。结论：提示目前尚无临床证据表明C反应蛋白作为冠心病的独立指标。 　　【关键词】 C反应蛋白 冠心病 循证医学 金标准 诊断试验 　　Evaluation of the Value of Creactive Protein in Literature of Coronary Heart Disease based on Evidencebased Medicine 　　CHEN Zhixiao,YANG Fengai，ZHANG Huirong，WU Shaodong 　　(Yangjiang Peoples Hospital，Yangjiang,Guangdong 529500,China;Combing Sinowestern Hospital of Yangjiang,Yangjiang,Guangdong 529503,China;The Fifth Affiliated Hospital of Sun Yatsen University，Zhuhai,Guangdong 519000,China) 　　Abstract: Objective To evaluate the value of Creactive in literatures of coronary heart disease based on evidencebased medicine. Methods The literatures were evaluated according to the evidencebased medicine principles. Main outcomes include design methods，sample screening establishment of control group，blind method，and criteria of diagnostic trials. Results In the 65 collected reports，there were 49 reports which had explained where the study objects come from，gold standard was adopted in 27 reports，blind method was adopted in 1 report，cut off point was not adopted in the litreratures and criteria of diagnostic trials such as sensitivity，specificity and likelihood ratio were incomplete. Conclusion There is no evidence to implicate that Creactive protein is considered an independent predictor of the diagnosis of coronary heart disease. 　　Key words:Creactive protein;Coronary heart disease;Evidencebased medicine;Gold standard;Diagnosis tests 　　我国冠心病(CHD)的发病率呈逐年增长趋势，北京地区的冠心病发病率增长率为1.7%[1]。而发病机制尚未完全清楚，有学者认为动脉硬化斑块不是简单的脂质沉积病，而是全身动脉粥样硬化斑块的一种慢性炎症发应[2]。诊断冠心病的金标准(gold standard)是冠状动脉造影，但由于价格昂贵，操作繁琐，不少学者都想用其他方法代替。C反应蛋白(CRP)是否能作为CHD的独立危险因素，国内还存在着较大的争论。本文将2006年4月以前利用CRP诊断CHD的国内文献进行评价，按照循证检验