摘要目的 探讨血清 IgG4在鉴别自身免疫性胰腺炎(AIP)与胰腺癌中的应用价值.方法 计算机检索2017年6月1日前在Medline、EMBASE、Springer link、万方、维普以及中国知网公开发表的有关血清IgG4在鉴别AIP与胰腺癌中应用价值的相关文献. 严格按照纳入、排除标准筛选文献并提取数据,采用Stata 12.0软件评估文献发表偏倚,采用质量评价工具(QUADAS)进行文献质量评估,采用Meta-Disc 1.4统计软件进行异质性分析和综合定量合成,计算汇总的灵敏度、特异度、阳性似然比及诊断比值比,绘制综合受试者工作特征(SROC)曲线,将纳入研究分别按地域、诊断标准、血清IgG4检测方法进行亚组分析. 结果 共纳入16篇文献,IgG4对鉴别诊断AIP与胰腺癌的汇总灵敏度为0.727(95%CI:0.691~0.761),汇总特异度为0.924(95%CI:0.907~0.939),汇总阳性似然比为10.103(95%CI:6.795 ~15.022),汇总诊断比值比为50.644(95%CI:26.473 ~96.883). 亚组分析显示地域是导致异质性的主要来源. Deeks漏斗图显示不存在发表偏倚. 敏感性分析结果稳定. 结论 血清IgG4在鉴别AlP与胰腺癌中的诊断效能较高,但由于地域不同,各地区的诊断效能不一致. 仍需高质量的前瞻性文章为我国诊断AIP提供依据.

abstractsObjective To investigate the usefulness of serum IgG4 in distinguishing autoimmune pancreatitis(AIP)from pancreatic cancer. Methods The related studies about the usefulness of serum IgG4 in distinguishing autoimmune pancreatitis from pancreatic cancer which were published in Medline, EMBASE,Springer link,Wanfang,Weipu and CNKI before June 1,2017 were searched.Studies were select-ed according to strict determined inclusion and exclusion criteria.Publication bias was analyzed by Stata 12.0 software.The quality of the literature was evaluated by the quality evaluation tool(QUADAS).Meta-Disc 1.4 statistical software was used for heterogeneity analysis and comprehensive quantitative synthesis, and the pooled sensitivity,specificity,positive likelihood and diagnostic odds ratio were calculated respec-tively,and summary receiver operating characteristic(SROC)curve was drawn.The subgroup analysis was performed according to the regional,diagnostic criteria and serum IgG4 detection method respectively. Results A total of 16 studies were included,the pooled sensitivity was 0.727(95%CI:0.691 to 0.761), the pooled specificity was 0.924(95%CI:0.907 to 0.939),the pooled positive likelihood ratio was 10.103 (95%CI:6.795 to 15.022),the pooled diagnostic odds ratio was 50.644(95%CI:26.473 to 96.883) .Subgroup analysis showed that the region was the leading source of heterogeneity.Deeks revealed no publica-tion bias,and sensitivity analysis revealed that the results of this meta-analysis were stable.Conclusion Serum IgG4 has high efficiency in the identification of AIP and pancreatic cancer,while due to geographical differ-ences,the regional diagnostic efficacy is inconsistent.More high-quality forward-looking articles for diagno-sis of AIP are needed to provide basis.