髓样细胞触发受体1诊断成人脓毒症准确性的Meta分析

Meta-analysis of diagnostic value of the triggering receptor expressed on myeloid cells-1 for adult sepsis

目的探讨髓样细胞触发受体1(Triggering receptor expressed on myeloid cells-1,TREM-1)诊断脓毒症的准确性。方法计算机检索CNKI、万方、维普、MEDLINE、EMBASE、COCHRANE图书馆等数据库,检索时间为建库至2012年9月,筛选TREM-1诊断脓毒症的文献。使用Meta-Disc 1.4和Stata version 12.0软件检验每篇文献间的异质性,并根据异质性结果选择相应效应模型进行加权定量合并,计算敏感度、特异度等指标。绘制受试者工作特征曲线(SROC)并计算曲线下面积(AUC)。使用QUADAS工具对纳入文献进行质量评价。结果最终纳入8篇文献行meta分析,TREM-1诊断脓毒症的合并敏感度和特异度分别为0.69(95%CI:0.66～0.72)和0.74(95%CI:0.70～0.77),合并阳性似然比(PLR)和阴性似然比(NLR)分别为3.36(95%CI:2.23～5.07)和0.29(95%CI:0.19～0.43),诊断比值比为14.81(95%CI:6.14～35.71),AUC为0.87,Q指数为0.80。结论 TREM-1对于脓毒症的诊断具有一定的价值,还需进一步研究其诊断脓毒症的准确性。

Objective To evaluate the value of the triggering receptor expressed on myeloid cells-1 （TREM-1） for di- agnosis of adult sepsis. Methods CNKI, Wanfang Data, Weipu Data, MEDLINE, EMBASE and COCHRANE library were searched to screen relevant Chinese and English articles till September 2012. QUADAS was used to assess the methodological quality of each study. Statistical analysis was performed by employing Meta-Disc 1.4 and Stata version 12.0 software. Weighted quantitative merger was used according to the heterogeneity results, sensitivity, specific de- grees were calculated. Summary receiver operating characteristic curves were used to summarize overall test perfor- mance, QUADAS was used to evaluate the quality of literature. Results 8 studies were included. The summary esti- mates sensitivity and specificity for TREM-1 in the diagnosis of sepsis were 0.69 （95%CI： 0.66-0.72） and 0.74 （95% CI： 0.70-0.77） respectively; positive likelihood ratio （PLR） and negative likelihood ratio （NLR） were 3.36 （95%CI： 2.23-5.07） and 0.29 （95%C1： 0. 19-0.43） respectively; diagnostic odds ratio was 14.81 （95%CI： 6.14-35.71）, and the AUC of SROC was 0.87. Conclusion TREM-1 plays a role in diagnosing sepsis, it is right to take further studies to confirm the predictive value.