Clinical Focus ›› 2021, Vol. 36 ›› Issue (7): 587-594.doi: 10.3969/j.issn.1004-583X.2021.07.002

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Diagnostic value of serum IgG4 for IgG4-related diseases: A meta-analysis

Ding Hang, Liu Yuan, Zhang Lianfeng, Zhou Lin()   

  1. Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
  • Received:2020-11-05 Online:2021-07-20 Published:2021-08-02
  • Contact: Zhou Lin E-mail:zl372@126.com

Abstract:

Objective To systematically evaluate the diagnostic value of serum IgG4 for IgG4-related diseases (IgG4-RD).Methods All related English studies to explore diagnostic value of serum IgG4 in IgG4-related diseases published in PubMed, EMBASE, Wangfang, Weipu and CNKI from January 1st, 2011 to January 1st, 2020 were searched by computer. Strict inclusion and exclusion criteria for literature screening and data extraction were established, the quality assessment was made by the quality evaluation tool (QUADAS-2), and meta-disc 1.4 software and the “Midas” command in STATA15.0 software were used for heterogeneity analysis and comprehensive quantitative synthesis. The pooled sensitivity, specificity, diagnostic advantage ratio, positive likelihood ratio and negative likelihood ratio were calculated respectively, and the relevant forest map was drawn, and the summary receiver operating curve (SROC) was fitted. The included literature were subgroup analyzed by region, disease type and sample size. Results A total of 17 articles and 17 095 patients were included in this meta-analysis. The cut-off value of IgG4 ranged from 1.3 to 1.44 g/L, the pooled sensitivity was 0.88(95%CI:0.81-0.93), the pooled specificity was 0.89(95%CI: 0.83-0.93), the pooled positive likelihood ratio was 8.3(95%CI: 5.1-13.7), the pooled negative likelihood ratio was 0.13(95%CI: 0.08-0.22) and the diagnostic advantage ratio was 62 (95%CI:25-153),respectively. The diagnostic value of serum IgG4>2×ULN (2.7-2.8 g/L) was reported in 11 studies, and the pooled sensitivity was 0.59(95%CI: 0.47-0.7), the pooled specificity was 0.96(95%CI: 0.94-0.97), the pooled positive likelihood ratio was 14.3(95%CI:9.1-22.7), the pooled negative likelihood ratio was 0.42(95%CI: 0.32-0.57), and the pooled diagnostic advantage ratio was 34(95%CI:17-69). Subgroup analysis showed that geography, whether only AIP patients were included, and sample size of IgG4-RD patients were all possible sources of heterogeneity. Deeks funnel plot showed no publication bias, and the sensitivity analysis revealed that the analysis result were stable and reliable. Conclusion Serum IgG4 has a high reference value in the diagnosis of IgG4-RD, and there is no significant diagnostic advantage in increasing the cut-off value to 2×ULN. This result still needs to be verified by more prospective and high-quality diagnostic tests.

Key words: immunoglobulin G, IgG4-related diseases, diagnosis, meta-analysis

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