23.45 (95%CI ) 0.11 (95%CI ) (95%CI ) (pleural effusion);

Transcription

1 CHEST -γ -γ -γ -γ 22 -γ 0.89 (95%CI ) 0.97 (95%CI ) (95%CI ) 0.11 (95%CI ) (95%CI ) -γ -γ -γ (interferon); (pleural effusion); (tuberculosis) AUC = area under the curve; CI = confidence interval; DOR = diagnostic odds ratio; IFN = interferon; NLR = negative likelihood ratio; PLR = positive likelihood ratio; QUADAS = quality assessment for studies of diagnostic accuracy; RDOR = relative diagnostic odds ratio; ROC = receiver operating characteristic; SROC = summary receiver operating characteristic; STARD = standards for reporting diagnostic accuracy; TPE = tuberculous pleural effusion 228

2 / / / 10 [1] Medline ( ) Embase ( ) Web of Science ( ) BIOSIS (1993 [2] 2006) LILACS ( ) Cochrane (TPE) tuberculosis Mycobacterium TPE 10% tuberculosis pleurisy / pleuritis pleural effusion / pleural fluid interferon / IFN sensitivity specificity accuracy [3] TPE TPE [4] (IFN) -γ TPE IFN-γ (1) [5] TPE IFN-γ TPE ( ) ( (PLR) (NLR) ) IFN-γ (DOR) 13 (2) IFN-γ 10 ( ) IFN-γ TPE IFN-γ IFN-γ TPE ( ) ( ) IFN-γ ( ) (NCET-04- (ROC) (SPSS 0835) ( ) Chicago IL) 1 (STARD 25 ) (86) (86) 771 [6] ( hzshi@vip.tom.com ) (QUADAS CHEST

3 1 / TP FP FN TN STARD QUADAS Ribera [16] / RIA 2 IU / ml Hsu [17] / ELISA 10 IU / ml Shimokata [18] / RIA Maeda [19] / ELISA 300 pg / ml Valdes [20] / ELISA 140 pg / ml Aoki [21] / ELISA 0.3 IU / ml Soderblom [22] / ELISA 1.5 pg / ml Kim [23] / RIA 9.1 IU / ml Ogawa [24] / ELISA 5 IU / ml Wongtim [25] / ELISA 240 pg / ml Villegas [26] / ELISA 6 IU / ml Yamada [27] / RIA 3.1 IU / ml Aoe [28] / ELISA 5.7 IU / ml Villena [29] / RIA 3.7 IU / ml Wong [30] / ELISA 60 pg / ml Poyraz [31] / ELISA 12 pg / ml Sharma [32] / ELISA 138 pg / ml El-Ansary [33] / ELISA 3.1 IU / ml Gao [34] / ELISA 61.7 pg / ml Okamoto [35] / ELISA 99.3 pg / ml Sharma [36] / ELISA pg / ml Morimoto [37] / ELISA 248 pg / ml ) ( version 8.2 (Stata Corporation College Station ) Texas) Meta-Test version 0.6 (New England Medical Center Boston MA) Meta-DiSc for Win- [7] (1) dows XI Cochrane Colloquium (Barcelona Spain) ( ) (2) (3) ( ) PLR NLR DOR (4) (SROC) [8, 9] IFN-γ [9, 10] SROC [11, 12] χ 2 Fisher [8] Stata 230

4 STARD QUADAS IFN-γ TPE ( ) IFN-γ [16 49] [38, 39] 2 TPE IFN-γ [40, 41] 2 TPE [42 45] 10 4 [46 49] DOR 4 (RDOR) Villena [46] [29] ( [13, 14] ) Sharma [47] Banga [32] Egger Hiraki [48, 49] Aoe [28] [15] [15 37] 22 TPE 782 TPE STARD QUADAS / / Ribera [16] / / 50 / Hsu [17] / / 20 / Shimokata [18] / / 20 / Maeda [19] / / 7 / Valdes [20] / / 110 / Aoki [21] / / 28 / Soderblom [22] / / 48 / Kim [23] / / 31 / Ogawa [24] / / 32 / Wongtim [25] / / 27 / Villegas [26] / / 79 / Yamada [27] / / 49 / Aoe [28] / / 36 / Villena [29] / / 513 / Wong [30] / / 34 / Poyraz [31] / / 30 / Sharma [32] / / 37 / El-Ansary [33] / / 24 / Gao [34] / / 49 Okamoto [35] / / 32 / Sharma [36] / / 17 / Morimoto [37] / / 46 / CHEST

5 (45.5%) 13 (59.1%) 11 (50.0%) IFN-γ 10 (63.3%) IFN-γ TPE ( %CI ) ( % CI ) PLR (95%CI ) NLR 0.11 (95% CI ) DOR (95% CI γ 504.2) PLR NLR DOR χ (P 0.001) (P = - γ 0.050) (P =0.446) (P 0.001) 0.89 (95%CI ) (P = 0.091) NLR ROC %CI 0.97 (95%CI ) 85% ( 96 (21 595) ) ROC [34] TPE SROC [22, 26] 2 IFN-γ SROC TPE Q ROC ( ) 19 SROC Q [16 21, 23 25, 27 33, 35 37] TPE ( ) SROC (Q ) 0.95 (AUC) 0.99 ( 0.98) ( )

6 ( ) ( 5%) [50 52] (24% [51, 53] 58%) [50, 52] ( ) [50] AUC =0.99 =0.98 ( ) [54] TPE γ (SROC) TPE INF-γ -12p TPE [45, 55] SROC [6] STARD Hiraki [49] ROC INF-γ 6 ( 1) QUADAS [7] TPE 1 0 (AUC 1.00) - 1 ( 1) -2 (AUC 0.99) IFN-γ TPE RDOR (AUC 0.96) -18 (AUC 0.95) 3 RDOR (AUC 0.93) -12p40 (AUC 0.87) SROC AUC / IFN-γ (Q Egger ) 0.95 AUC 0.99 (P = 0.023) [19] ( 3) IFN-γ TPE ( 0.70) ( 0.90) STARD QUADAS (n =21) TPE TPE [56] DOR CHEST

7 log DOR ( ) [59] STARD QUADAS IFN-γ TPE RDOR log DOR (STARD 13 QUADAS -γ 10) NLR ) ) SDOR / Egger (P = (DOR ( 0.023) DOR DOR 0 ( ) DOR 1 ( 5%) [50 52] 20% 40% TPE [50, 51] DOR % [50] 3wk SROC DOR [57] IFN-γ [57, 58] PLR NLR ( ( ) TPE ) [58] PLR TPE IFNγ TPE 23 TPE [60] NLR 0.11 IFN-γ TPE 10% TPE IFN-γ Greco [5] IFN-γ TPE IFN-γ

8 Greco 15 Egger M, et al. BMJ 1997;315: Ribera E, et al. Chest 1988;93: Shimokata K, et al. Chest 1991;99: Maeda J, et al. Clin Exp Immunol 1993;92: Valdes L, et al. Chest 1993;103: Aoki Y, et al. Respir Med. 1994;88: TPE TPE 24 Ogawa K, et al. Tuber Lung Dis 1997;78: Wongtim S, et al. Thorax 1999;54: Villegas MV, et al. Chest 2000;118: IFN-γ TPE ( IFN-γ ) TPE IFN-γ A. Kaya, C. F. Wong, E. Ribera, K. Ogawa, K. Shimokata, L. Valdés, N. G. Saravia, S. K. Sharma, S. Wongtim, T. Morimoto, T. Pettersson, V. Villena, W. H. Hsu, Y. C. Kim, Y. Aoki, Y. Yamada, and Z. C. Gao. 1 National Technical Steering Group of the Epidemiological Sampling Survey for Tuberculosis. Chin J Tuberc Respir Dis 2002; 25:3 7 2 Dye C. Lancet 2006;367: Ellner JJ, et al. Semin Respir Infect 1988;3: Light RW. N Engl J Med 2002;346: Greco S, et al. Int J Tuberc Lung Dis 2003;7: Bossuyt PM, et al. BMJ 2003;326: Whiting P, et al. BMC Med Res Methodol 2003;3:25 8 Deville WL, et al. BMC Med Res Methodol 2002;2:9 9 Moses LE, et al. Stat Med 1993;12: Lau J, et al. Ann Emerg Med 2001;37: Irwig L, et al. Ann Intern Med 1994;120: Vamvakas EC. Arch Pathol Lab Med 1998;122: Suzuki S, et al. J Clin Epidemiol 2004;57: Westwood ME, et al. BMC Med Res Methodol 2005;8:20 17 Hsu WH, et al. Taiwan Yi Xue Hui Za Zhi 1989;88: Soderblom T, et al. Eur Respir J 1996;9: Kim YC, et al. Korean J Intern Med 1997;12: Yamada Y, et al. Respir Med 2001;95: Aoe K, et al. Chest 2003;123: Villena V, et al. Am J Med 2003;115: Wong CF, et al. Respir Med 2003;97: Poyraz B, et al. Tuberk Toraks 2004;52: Sharma SK, et al. J Interferon Cytokine Res 2004;24: EL-Ansary AK, et al. Biochimica Clinica 2005;29: Gao ZC, et al. Chin Med J 2005;118: Okamoto M, et al. J Lab Clin Med 2005;145: Sharma SK, et al. J Clin Lab Anal 2005;19: Morimoto T, et al. Respir Med 2006;100: Barnes PF, et al. J Immunol 1990;145: Barbosa T, et al. Microbes Infect 2006;8: Yanagawa H, et al. Eur Respir J 1996;9: Oshikawa K, et al. Am J Respir Crit Care Med 2002;165: Chen YM, et al. Lung Cancer 2001;31: Oshikawa K, et al. Int J Tuberc Lung Dis 2001;5: Kim YK, et al. Lung 2001;179: Okamoto M, et al. Chest 2005;128: Villena V, et al. Eur Respir J 1996;9: Sharma SK, et al. J Clin Immunol 2002;22: Hiraki A, et al. Int J Tuberc Lung Dis 2003;7: Hiraki A, et al. Chest 2004;125: CHEST

9 50 Escudero Bueno C, et al. Arch Intern Med 1990;150: Epstein DM, et al. Chest 1987;91: Valdes L, et al. Arch Intern Med 1998;158: Seibert AF, et al. Chest 1991;99: Perez-Rodriguez E, et al. Curr Opin Pulm Med 2000;6: Wong PC. Respirology 2005;10: Glas AS, et al. J Clin Epidemiol 2003;56: Deeks JJ. Systematic reviews of evaluations of diagnostic and screening tests. In: Egger M, et al, eds. Systematic reviews in health care. Meta-analysis in context. London: BMJ Publishing Group, 2001: Jaeschke R, et al. Diagnostic tests. In: Guyatt G, et al, eds. Users guides to the medical literature. A manual for evidencebased clinical practice. Chicago: AMA Press, 2002: Petitti DB. Stat Med 2001;20: Light RW. Arch Intern Med 1998;158(18): CHEST 2007;131: CHEST 247 CHEST E. Peripheral vascular disease. The combination of decreased exercise capacity (low Vo2), available cardiac and ventilatory reserve, normal ECG, and very early anaerobic threshold with metabolic acidosis, is best explained by peripheral vacular disease. This patient had severe atherosclerosis supported by the weak peripheral pulses. Although the patient has obstructive airways disease, the achieved peak VE was below the calculated maximal voluntary ventilation. This, coupled with the improvement in arterial blood gas measurements with exercise,rules out ventilatory limitation. Cardiac limitation is characterized by early peak heart rate at submaximal exercise capacity, a drop in blood pressure, and/or development of chest pain or ECG change, none of which were observed in this patient. A submaximal exercise test is also characterized by a low exercise capacity, large ventilatory and cardiac reserve but not with an early anaerobic threshold and the degree of metabolic acidosis seen in this patient. If the problem were deconditioning the peak heart rate should have been reached early and the anaerobic threshold should have occurred at least above 40% of the predicted oxygen uptake. Tjahja I,et al. Clin Chest Med 1994;15: Levander-Lindgren M,et al.acta Med Scand 1962;172: Jones N. Clinical exercise testing.philadelphia: WB Saunders Co;