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背景虽然非心血管胸痛(NCCP)具有较高的医疗费用,但还是缺乏针对其诊断研究的指导。当前工作旨在识别重要的诊断指标及其在诊断特定和非特定情况中潜在NCCP的准确性。方法 2012年5月进行系统评价和荟萃分析,对6个数据库进行检索,并进行手动检索和参考书目检索。纳入评估NCCP患者的诊断试验研究。排除每组患者<30例,评估急性心血管疾病的诊断试验。采用似然比表示诊断精确度,采用分层贝叶斯模型进行诊断灵敏度和特异度的联合荟萃分析。结果在6 316个研究中,对260个回顾了全文,最终纳入28个[包括20个胃食管反流病(GERD)研究、3个肌肉骨骼疼痛研究和5个精神疾病研究]。15个研究质量良好,13个研究质量中等。典型的GERD症状诊断GERD的阳性似然比分别为2.70、2.75,阴性似然比分别为0.42、0.78;非典型GERD症状诊断GERD的阳性似然比为0.49,阴性似然比为2.71。质子泵抑制剂(PPI)测试阳性反应诊断GERD的阳性似然比分别为5.48、7.13、8.56,阴性似然比分别为0.24、0.25、0.28;6个研究的平均灵敏度和特异度分别为0.89[95%CI(0.28,1.00)]、0.88[95%CI(0.26,1.00)]。恐惧和焦虑筛查得分可以进一步识别需要检测焦虑或恐慌异常的个体。通过临床表现诊断肌肉骨骼疼痛要么阳性似然比是一般到中等和阴性似然比是较差,要么反之亦然。结论对NCCP患者的病史、症状和临床表现彻底的临床评估可以确定最合适的诊断试验。对大剂量PPI疗法的治疗反应提供了关于GERD的重要信息,应该及早考虑到。恐慌和焦虑症通常是未确诊的,应在胸痛的鉴别诊断中予以考虑。
Background Although non-cardiovascular chest pain (NCCP) has high medical costs, it still lacks guidance for its diagnostic study. Current work aims to identify important diagnostic indicators and their potential for accurate NCCP in the diagnosis of specific and non-specific conditions. Methods In May 2012, systematic reviews and meta-analyzes were conducted to search six databases and to conduct manual and bibliographic search. Diagnostic trials included in the evaluation of NCCP patients. Excluding <30 patients in each group, a diagnostic test to assess acute cardiovascular disease. The diagnostic accuracy was expressed as a likelihood ratio and a joint meta-analysis of diagnostic sensitivity and specificity using a layered Bayesian model. Results Six of the 6 316 studies reviewed the full text of 260 and eventually included 28 [including 20 gastroesophageal reflux disease (GERD) studies, 3 musculoskeletal pain studies and 5 psychiatric studies]. Fifteen studies were of good quality and 13 were of medium quality. The positive likelihood ratios of GERD in diagnosis of typical GERD were 2.70 and 2.75, respectively, and the negative likelihood ratios were 0.42 and 0.78, respectively. The positive likelihood ratio of GERD was 0.49 and the negative likelihood ratio was 2.71 in diagnosing atypical GERD. The positive likelihood ratios of GERD in positive diagnosis of proton pump inhibitor (PPI) test were 5.48, 7.13 and 8.56 respectively, and the negative likelihood ratios were 0.24, 0.25 and 0.28, respectively. The average sensitivity and specificity of 6 studies were 0.89 [ 95% CI (0.28, 1.00)], 0.88 [95% CI (0.26, 1.00)]. Fear and anxiety screening scores can further identify individuals who need to detect anxiety or panic disorder. Diagnosis of musculoskeletal pain by clinical manifestation is either less likely than positive or negative, and vice versa. Conclusion A thorough clinical evaluation of the history, symptoms and clinical manifestations of NCCP patients can determine the most suitable diagnostic test. The response to treatment with high-dose PPI therapy provides important information about GERD and should be taken into consideration as early as possible. Panic and anxiety disorders are usually undiagnosed and should be considered in the differential diagnosis of chest pain.