可溶性髓系细胞触发受体-1在呼吸机相关性肺炎早期诊断中的价值

Study on the value of soluble triggering receptor expression myeloid cells-1 in early diagnosis ventilator-associated pneumonia

目的通过Meta分析探讨可溶性髓系细胞触发受体-1(sTREM-1)在呼吸机相关性肺炎(VAP)早期诊断中的价值。方法通过检索PubMed、MEDLINE、Embase、Cochrane、中国知网、万方、维普数据库,收集有关sTREM-1和VAP的文献,用QUADAS-2量表进行文献质量评价,Stata 13.0软件进行Meta分析。结果检索日期截至2019年6月30日,共有12篇文献入选。研究发现VAP组sTREM-1水平明显高于无呼吸机相关性肺炎(no-VAP)组,差异有统计学意义(Z=3.05,P=0.002)。异质性分析提示入选文献存在高度异质性(I2=95.0%,P<0.001),与作者国籍和文献结论有关,而与课题设计、检测方法和诊断金标准无关。共7篇文献入选诊断试验的Meta分析,合并灵敏度为0.82(0.76,0.86),特异度为0.70(0.59,0.79),阳性似然比为2.70(1.90,3.90),阴性似然比为0.26(0.18,0.38),诊断比值比为10(5,21)。受试者工作特征曲线下面积为0.84(0.81~0.87)。结论sTREM-1水平检测可用于VAP的早期诊断,有一定的灵敏度和特异度,但结论可靠性较低。

Objective To explore the value of soluble triggering receptor expression myeloid cells-1(sTREM-1)in early diagnosis of ventilator-associated pneumonia(VAP)by Meta-analysis.Methods PubMed,MEDLINE,Embase,Cochrane,CNKI,Wanfang and VIP databases were retrieved.The literatures about serum sTREM-1 in the diagnosis of VAP were collected.QUADAS-2 scale was used to evaluate the quality of diagnostic experiments.Stata 13.0 software was used to complete Meta-analysis.Results The date of retrieval was up to June 30 in 2019 and a total of 12 articles were selected.The research found that the sTREM-1 level of VAP group was significantly higher than that of no-VAP group,and there was significant difference between the two groups(Z=3.05,P=0.002).Heterogeneity analysis indicated that there was a high degree of heterogeneity in the selected literature(I2=95.0%,P<0.001),which related to author′s nationality and literature conclusion,but had no relationship with the subject design,detection method and diagnostic gold standard.A total of 7 literatures were included in the Meta-analysis of diagnostic experiments.The combined sensitivity was 0.82(0.76,0.86),specificity was 0.70(0.59,0.79),positive likelihood ratio was 2.70(1.90,3.90),negative likelihood ratio was 0.26(0.18,0.38)and diagnostic ratio(DOR)was 10(5,21).The area under receiver operator characteristics curve was 0.84(0.81-0.87).Conclusion sTREM-1 level might be used in the early diagnosis of VAP,with some sensitivity and specificity,but the conclusion is less reliable.