帕金森病,包括帕金森病(PD),多系统萎缩(MSA),路易体痴呆(DLB),皮质基底综合征(CBS)和进行性核上性麻痹(PSP)往往因症状重叠和缺乏精确的生物标志物而被误诊.此外,目前还没有确定前驱疾病如REM行为障碍(RBD)的进展和转化的方法。细胞外囊泡(EV),含有生物分子的混合物,已经成为帕金森病诊断的潜在来源。然而,以往研究中的不一致使得其诊断潜力不明确.我们进行了荟萃分析,遵循PRISMA准则,为了评估从各种体液中分离出来的普通电动汽车的诊断准确性,包括脑脊液(CSF),等离子体,血清,尿液或唾液,区分帕金森病患者与健康对照(HCs)。荟萃分析包括21项研究,包括1285名PD患者,24与MSA,105与DLB,99与PSP,101与RBD和783HC。仅对患有PD和HCs的患者进行了进一步的分析,考虑到其他比较的数量有限。使用双变量和分层接收机操作特性(HSROC)模型,荟萃分析显示,在区分PD和HCs患者方面,诊断准确性中等,具有实质性的异质性和发表偏倚。修剪和填充方法揭示了至少两项缺失的研究,其诊断准确性为零或低。CSF-EV显示出更好的整体诊断准确性,而等离子电动汽车的性能最低。与源自中枢神经系统的电动汽车相比,普通电动汽车显示出更高的诊断准确性,这更耗时,隔离劳动力和成本密集型。总之,在信守承诺的同时,由于现有的挑战,在一般电动汽车中利用生物标志物进行PD诊断仍然不可行。重点应转向通过标准化来协调该领域,合作,和严格的验证。国际细胞外囊泡学会(ISEV)目前的努力旨在通过严格和标准化来提高EV相关研究的准确性和可重复性。旨在弥合理论与实际临床应用之间的差距。
Parkinsonian disorders, including Parkinson\'s disease (PD), multiple system atrophy (MSA), dementia with Lewy body (DLB), corticobasal syndrome (CBS) and progressive supranuclear palsy (PSP) are often misdiagnosed due to overlapping symptoms and the absence of precise biomarkers. Furthermore, there are no current methods to ascertain the progression and conversion of prodromal conditions such as REM behaviour disorder (RBD). Extracellular vesicles (EVs), containing a mixture of biomolecules, have emerged as potential sources for parkinsonian diagnostics. However, inconsistencies in previous studies have left their diagnostic potential unclear. We conducted a meta-analysis, following PRISMA guidelines, to assess the diagnostic accuracy of general EVs isolated from various bodily fluids, including cerebrospinal fluid (CSF), plasma, serum, urine or saliva, in differentiating patients with parkinsonian disorders from healthy controls (HCs). The meta-analysis included 21 studies encompassing 1285 patients with PD, 24 with MSA, 105 with DLB, 99 with PSP, 101 with RBD and 783 HCs. Further analyses were conducted only for patients with PD versus HCs, given the limited number for other comparisons. Using bivariate and hierarchal receiver operating characteristics (HSROC) models, the meta-analysis revealed moderate diagnostic accuracy in distinguishing patients with PD from HCs, with substantial heterogeneity and publication bias. The trim-and-fill method revealed at least two missing studies with null or low diagnostic accuracy. CSF-EVs showed better overall diagnostic accuracy, while plasma-EVs had the lowest performance. General EVs demonstrated higher diagnostic accuracy compared to CNS-originating EVs, which are more time-consuming, labour- and cost-intensive to isolate. In conclusion, while holding promise, utilizing biomarkers in general EVs for PD diagnosis remains unfeasible due to existing challenges. The focus should shift toward harmonizing the field through standardization, collaboration, and rigorous validation. Current efforts by the International Society For Extracellular Vesicles (ISEV) aim to enhance the accuracy and reproducibility of EV-related research through rigor and standardization, aiming to bridge the gap between theory and practical clinical application.