Diagnostic Accuracy Of Fractional Exhaled Nitric Oxide For Bronchial Asthma:A Meta-analysis

Objective: The purpose of this meta—analysis is to evaluate significance of fractional exhaled nitric oxide(FeNO)in asthma diagnosis.Methods: Using computer to search the Pubmed,EMBASE,the Cochrane Library,CNKI,VIP,Wan Fang,CBM to find a comprehensive collection of the current research on exhaled nitric oxide for the diagnosis of asthma from January 1,1990 to January 1,2017 published literature,according to the diagnostic test to evaluate the quality of-2(QUADAS-2)tool evaluation criteria to evaluate the quality of the selected documents,and by using the Cochrane collaboration software RevMan5.3 to test the published risk bias.Product data extraction and extract of the literature data.And the Meta-Disc(1.4)software was used to analyze heterogeneity,and calculate the diagnostic advantage after the merger ratio(DOR),pooled sensitivity,pooled specificity,positive likelihood ratio combined with and negative likelihood ratio,The receiver operating characteristic curve(SROC)analysis was performed and was used to obtain the area under the SROC curve.Results: A total of 1389 articles were retrieved,including 934 Chinese literatures and 455 articles in English literature.After screening,a total of 9 articles were selected according to the standard,including 1940 patients.The literature quality evaluation was higher,and there was no publication bias(t=-0.59,p=0.571>0.05).Heterogeneity test results: 1.The Spearman correlation coefficient of the logarithm of sensitivity and specificity of 1-was 0.017,P = 0.966;2.The heterogeneity caused by the non threshold effect was observed among the participants,and the partial heterogeneity caused by the non threshold effect was removed,After the regression analysis,the reasons of heterogeneity were not found,and the random effect model was combined with the statistical indicators.The FeNO threshold between 15-25 ppb,sensitivity and specificity were respectively 0.74 and 0.70;the FeNO threshold between 26-35 ppb,sensitivity and specificity were respectively 0.60 and 0.86;the FeNO threshold between 36-45 ppb,sensitivity and specificity were respectively 0.80,0.80.The pooled sensitivity was 74%,the pooled specificity was 79%,the pooled positive likelihood ratio was 3.63,the pooled negative likelihood ratio was 0.29,and the diagnostic odds ratio value was 12.25,the pooled AUC was 0.8502.Conclusions: 1.FeNO is a simple and safe method for the detection of airway inflammation.The sensitivity,specificity and overall diagnostic efficacy of FeNO in diagnosing asthma are moderate.Clinically,FeNO is of great significance in the diagnosis of asthma and should be further studied.2.The value of FeNO in the diagnosis of asthma between 36-45 ppb.