目前,基础促肾上腺皮质激素(ACTH)的测量用于诊断马中的垂体中层功能障碍(PPID)。然而,尚未对其使用的证据进行系统审查。本研究旨在系统地审查有关基础ACTH诊断测试的敏感性和特异性的证据。在2019年1月,2020年9月和2021年1月对电子数据库进行了系统搜索,以查找这些日期之前发布的英语出版物。筛选,作者使用预定义的标准对出版物进行数据提取和质量评估.研究设计,纳入研究的方法和信息采用诊断准确性报告标准(STARD)检查表进行评估.使用诊断准确性研究质量评估工具(QUADAS-2)质量评估工具评估偏倚和适用性的风险。由于确定的偏见和明显的研究之间的差异,没有进行荟萃分析。删除重复项后,确定了415种出版物,其中25项进行了全面评估,其中11项符合纳入标准。在大多数研究中,据报道,基础ACTH具有良好的敏感性(总体中位数为75.5%;四分位距[IQR],64.0-86.5%;范围,36.0-100%)和优异的特异性(总体中位数,95.2%;IQR,84.2-98.9%;范围,63.3-100%)。然而,QUADAS-2和STARD评估强调,研究没有利用最佳研究设计和/或研究人群来评估诊断测试,大多数研究都存在偏见。或提供的信息不足以充分评估可能的偏见。基于这篇综述,基础ACTH在排除PPID方面比检测更好。
Measurement of basal adrenocorticotrophic hormone (ACTH) is currently used to diagnose pituitary pars intermedia dysfunction (PPID) in horses, yet a systematic
review of the evidence for its use has not been undertaken. This study aimed to systematically
review evidence regarding the sensitivity and specificity of the basal ACTH diagnostic test. Electronic databases were systematically searched in January 2019, September 2020 and January 2021, for English language publications published prior to these dates. Screening, data extraction and quality assessment of publications was undertaken by the authors using predefined criteria. Study design, methodology and information reported in included studies were assessed using Standards for Reporting of Diagnostic Accuracy (STARD) checklists. Risk of bias and applicability were appraised using the Quality Assessment tool for Diagnostic Accuracy Studies (QUADAS-2) quality assessment tool. Due to identified biases and marked between-study variations, meta-analysis was not undertaken. After removal of duplicates, 415 publications were identified, of which 25 were evaluated in full, with 11 of these meeting inclusion criteria. In most studies, basal ACTH was reported to have good sensitivity (overall median 75.5%; interquartile range [IQR], 64.0-86.5%; range, 36.0-100%) and excellent specificity (overall median, 95.2%; IQR, 84.2-98.9%; range, 63.3-100%). However, QUADAS-2 and STARD assessment highlighted that studies did not utilise optimal study design and/or study populations for the evaluation of a diagnostic test and the majority were subject to bias, or provided insufficient information to fully assess possible biases. Based on this
review, basal ACTH performed better at ruling out PPID than detecting it.