ChromID对艰难梭菌诊断价值的Meta分析

Meta-analysis of ChromID for diagnosis of clostridium difficile infection

目的通过Meta分析在较大样本量前提下，系统评价ChromID对艰难梭菌感染（CDI）的诊断价值。方法制定文献纳入、排除标准，通过计算机检索Pubmed、Cochrane图书馆、中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）和万方数据库等，获取有关ChromlD检测艰难梭菌的文献，检索关键词为ChromID、clostridium difficile、chromogenic agar，根据纳入、排除标准对文献进行筛选，并采用质量评价工具QUADAS对文献进行质量评价，提取数据。应用Meta—disc1．4软件进行分析。结果最终纳入5篇文献，样本量共l851例。纳入文献均为中高质量文献，进行异质性检验提示无阈值效应，但存在其他原因导致的非阈值性异质性，采用随机效应模型进行Meta分析。ChromID诊断粪便48h培养诊断结果的合并敏感度为0．793（95％C／．0．750～0．832）、合并特异度为0．942（95％C／：0．972—0．955）、合并阳性似然比为16．817（95％CI：7．042—40．157）、合并阴性似然比为0．124（95％CI：0．040—0．386）及诊断优势比为244．64（95％CI：17．711～3379．3）。受试者工作曲线下面积（AUCSROC）为0．9814以及Q。指数为0．9399。结论通过对ChromlD对艰难梭菌感染诊断价值进行Meta分析，发现ChromID具有较高的敏感度、特异度、阳性似然比及阴性似然比，可推荐应用于临床。

Objective To assess the diagnostic value of ChromID for Clostridium Clostridium infec- tion （CDI） on the premise of large sample size, with Meta-analysis. Methods The literature inclusion and exclusion standards were made, and the databases were searched, including PubMed, Cochrane Library, China Biology Medicine disc （CBM）, China National Knowledge Infrastructure （CNKI） and so on, using the keywords （ChromID, Clostridium difficile, and chromomgenic agar） along with each of the following words （detection, diagnosis, and infection）. Quality assessment of diagnostic accuracy studies （QUADAS） was used to evaluate the quality of the literature. The Meta-disc 1.4 software was used to analyze the data. Results Five studies on 1 851 patients were included in this meta-analysis. The pooled sensitivity was 0. 793 （95% CI： O. 750 ~0. 832） for the diagnosis of CDI on 48 h, the pooled specificity was 0. 942 （95% CI： O. 972 -0. 955）, the pooled positive likelihood ratio was 16. 817 （95% CI： 7. 042 -40. 157）, with negative likelihood ratio was 0. 124 （95% CI： 0. 040 -0. 386） and diagnostic odds ratio for 244.64 （95% CI： 17. 711 -3 379. 3）. The area under the working curve （AUCSROC） of the subjects was 0. 981 4 and the Q＊ index was 0. 939 9. Conclusions Meta-analysis on ChromID for diagnosis of clostridium difficile infection revealed ChromlD had higher sensitivity, specificity, positive likelihood ratio, and negative likeli- hood ratio, which can be recommended for clinical use.