基因检测对自发性细菌性腹膜炎诊断价值的Meta分析

A meta-analysis of diagnostic value of gene detection for spontaneous bacterial peritonitis

目的系统评价基因检测技术对自发性细菌性腹膜炎（SBP）的诊断价值。方法检索PubMed、web of Science、Cochrane Library、中国知网（CNKI），检索时间为建库至2015年3月，获得关于基因检测诊断SBP的临床价值的相关文献，对其进行诊断准确性研究质量评价工具（QUADAS）质量评价，双变量随机效应模型进行Meta分析。绘制综合受试者工作特征（SROC）曲线，并计算曲线下面积（Auc），比较采用Z检验。结果纳入5篇文献423个样本，基因检测诊断SBP的合并敏感度、特异度、诊断优势比、阳性似然比及阴性似然比分别为0．56（95％CI：0．49～0．62）、0．88（95%CI：0．83～0．92）、9．94（95％CJ：1．76～56．27）、4．35（95％CJ：1．05～18．10）和0．47（95％CJ：0．25～0．88），合并敏感度明显高于细菌培养诊断SBP的0．25（95％CI：0．19～0．31）。基因检测诊断SBP的AUC为0．8109，高于细菌培养的0．6598（Z=3．14，P〈0．01）。腹水多形核粒细胞（PMN）≥250×10^6／L亚组分析基因检测诊断SBP，除敏感度[0．64（95％CI：0．53～0．74）]高于细菌培养[0．39（95％CI：0．29～0．51）]外，其他上述指标均低于细菌培养。定量PCR检测诊断SBP，除敏感度[0．54（95％CI：0．47～0．61）]高于细菌培养[0．25（95%ACI：0．19～0．31）]外，其他上述指标同样均低于细菌培养。结论基因检测诊断SBP比细菌培养更灵敏，其诊断价值优势受诊断标准影响，定量PCR诊断SBP尽管也灵敏，但诊断价值低于细菌培养，还需要更多高质量的研究进一步验证。

Objective To systematically assess the diagnostic value of gene detection for spontaneous bacterial peritonitis （SBP）. Methods A literature search was performed in the database of PubMed, Web of Science, Cochrane Library and China National Knowledge Internet （CNKI） from databases establishing to March 2015. Relevant studies on diagnostic value of gene detection for SBP were retrieved. Quality assessment of diagnostic accuracy studies （QUADAS） was applied for the included studies. Meta-analysis was conducted using bivariate random effects model. Summary receiver operator characteristic curves （SROC） was conducted to calculate area under curve （AUC） and was compared using Z test. Results Five studies with 423 specimen involved were included in the meta-analysis. The pooled sensitivity, specificity, diagnostic odds ratio （DOR）, positive likelihood ratio and negative likelihood ratio of gene detection for the diagnosis of SBP were 0. 56 （95% CI：0. 49- 0. 62）, 0. 88 （95% CI： 0. 83- 0.92）, 9.94 （95%CI：1.76--56.27）, 4.35 （95%CI：1.05--18. 10） and 0.47 （95%CI：0. 25-0. 88）, respectively. The pooled sensitivity was significantly higher than that of bacterial culture （0.25[95% CI： 0.19- 0.31]）. The AUC of SROC of gene detection was 0. 810 9, which was significantly higher than that of bacterial culture （AUC：0. 659 8, Z=3.14, P〈0.01）. Subgroup analysis was conducted in patients with polymorphonuclear neutrophils （PMN）≥250 ×10^6/L in ascites. All the diagnostic indices of gene detection were inferior to those of bacterial culture for SBP, except for the sensitivity of gene detection for SBP （0. 64[95%CI：0. 53-0. 74] vs 0. 39[95%CI：0. 29-0. 51]）. The diagnostic value of quantitative polymerase chain reaction （qPCR） detection for SBP was inferior to that of bacterial culture in all the aspects except for the sensitivity （0. 54[95%CI：0. 47-0. 61] vs 0. 25[95%CI：0. 19-0. 31]）. Conclusions Gene detection shows higher sensitivity than bacterial culture. The diagnostic value of gene detection is influenced by diagnostic standards, qPCR also shows high sensitivity for SBP diagnosis, while the diagnostic value was inferior to bacterial culture. More researches with high quality are required to validate the results of this study.