■胰岛素瘤是反复低血糖的原因之一,急诊科入院的主要投诉之一。诊断胰岛素瘤的金标准是72小时的空腹测试,由于需要住院治疗,因此不方便且效率低下。研究发现,在OGTT期间测量胰岛素和C肽可能有助于诊断胰岛素瘤。我们旨在评估OGTT在胰岛素瘤诊断中的诊断价值。
■文献检索于2022年8月19日使用多个数据库(MEDLINE,Scopus,Embase,和科学直接)。包括所有测量OGTT作为诊断胰岛素瘤的诊断工具和72小时空腹测试作为参考标准的研究。所选研究的质量评估基于牛津大学循证医学中心和诊断准确性质量评估-2工具(QUADAS-2)。对纳入的研究进行定性分析。本研究在PROSPERO(CRD42022360205)上注册。
■共纳入两项病例对照研究(106例患者),存在偏倚风险,适用性关注度低。两项研究表明,在OGTT期间测量的胰岛素和C肽水平的组合具有高特异性,灵敏度,正预测值,与参考标准相比,诊断胰岛素瘤的阴性预测值。在一项研究中,8.305-(0.441×胰岛素2-h/0-h)-(1.679×C肽1-h/0-h)>0.351的逻辑回归模型具有最高的诊断价值(AUC0.97,敏感性86.5%,特异性95.2%,PPV94.1,净现值88.9)。
■在两项小型病例对照研究中发现,在2小时OGTT期间测量0小时和2小时胰岛素和C肽水平,共有106名患者具有良好的敏感性和特异性。然而,由于这些限制,未来的研究仍需验证OGTT在胰岛素瘤诊断中的潜在用途.
UNASSIGNED: Insulinoma is one of the causes of recurrent hypoglycemia, one of the chief complaints for emergency department admission. The gold standard in diagnosing insulinoma is a 72-hour fasting test which is inconvenient and inefficient as it requires hospitalization. Research has found that measurement of insulin and C-peptide during OGTT may help diagnose insulinoma. We aimed to assess the diagnostic value of OGTT in diagnosing insulinoma.
UNASSIGNED: The literature search was conducted on 19 August 2022 using several databases (MEDLINE, Scopus, Embase, and ScienceDirect). All studies that measured OGTT as diagnostic tools in diagnosing insulinoma and 72-hour fasting test as reference standard were included. The quality assessment of the selected studies was based on the Centre of Evidence-Based Medicine University of Oxford and the Quality Assessment of Diagnostic Accuracy-2 tool (QUADAS-2). Analysis of the included studies was performed qualitatively. This study was registered on PROSPERO (CRD42022360205).
UNASSIGNED: A total of two case-control studies (106 patients) were included, which were at risk of bias and low concern of applicability. Both studies demonstrated that the combination of insulin and C-peptide levels measured during OGTT had high specificity, sensitivity, positive predictive value, and negative predictive value in diagnosing insulinoma compared to the reference standard. A logistic regression model of 8.305 - (0.441 × insulin 2-h/0-h) - (1.679 × C-peptide 1-h/0-h) >0.351 has the highest diagnostic value in one study (AUC 0.97, Sensitivity 86.5%, Specificity 95.2%, PPV 94.1, NPV 88.9).
UNASSIGNED: The measurement of 0-h and 2-h insulin and C-peptide levels during 2-h OGTT was found in two small case-control studies with a total of 106 patients to have good sensitivity and specificity. However, due to these limitations, future research is still needed to validate the potential use of OGTT for the diagnosis of insulinoma.