聚合酶链反应和酶联免疫法对艰难梭菌感染诊断意义的Meta分析

Meta-Analysis of Polymerase Chain Reaction and Enzyme Immunoassays for Diagnosis of Clostridium Difficile Infection

目的:评价聚合酶链反应(PCR)及酶联免疫法(EIAs)检测艰难梭菌的准确性及敏感性。方法:通过计算机检索获得研究PCR及EIAs检测艰难梭菌的文献,按纳入标准筛选文献并提取有关准确度的数据,采用MetaDisc 1.4软件检验研究的异质性并进行Meta分析、绘制综合受试者工作特征曲线(SROC)。结果:从767篇文献中筛选出9篇符合纳入标准的研究,共涉及研究对象2 855例。异质性检验提示无阈值效应,但存在其他原因导致的异质性,按随机效应模式进行Meta分析。结果显示PCR与EIAs检测的敏感度分别为92%(89%-95%)和70%(65%-75%)、特异度分别为97%(97%-98%)和97%(96%-97%)、阳性似然比分别为37.37(20.54-67.99)和30.38(13.64-67.63)、诊断优势比分别为451.29(202.21-987.66)和161.20(46.84-554.74)。受试者工作特征曲线下面积(AUC)分别为0.980 7、0.968 7,Q+指数分别为0.934 8、0.917 8。结论:PCR较EIAs诊断艰难梭菌感染的准确度更高。

Objective： To evaluate the accuracy and sensitivity of polymerase chain reaction （PCR） and enzyme immunoassays （EIAs） in detecting clostridiurn difficile infection （CDI）. Methods： A comprehensive network search is performed to retrieve relevant studies on PCR and EIAs in the detection of clostridium difficile. Data were extracted and analyzed using software Meta-disc 1.4. Results： In 767 relevant studies, 9 studies were enrolled and 2 855 patients were included. Heterogeneity （except for threshold effect） was found within these studies. A meta-analysis was performed using the random effect model. The result showed sensitivity, specificity, positive likelihood ratio and diagnostic odds ratio in PCR and EIAs were 92% （89%-95%） vs. 70% （65%- 75%）, 97% （97%-98%） vs. 97% （96%-97%）, 37.37 （20.54-67.99） vs. 30.38 （13.64-67.63）, and 451.29 （202.21-987.66） vs. 161.20 （46.84-554.74）, respectively. The areas under summaryreceiver operating characteristics curve （AUC） were 0. 980 7 and 0. 968 7, and the Q indices were 0. 934 8 and 0. 917 8 for PCR and EIAs, respectively. Conclusion. Compared with EIAs, PCR has a higher accuracy in detecting CDI.