白细胞介素-6对新生儿脓毒症早期诊断价值的Meta分析

Early diagnostic value of interleukin-6 for sepsis in neonates:a meta-analysis

目的:探讨白细胞介素-6(IL-6)对新生儿脓毒症的早期诊断价值。方法:计算机检索获得IL-6对新生儿脓毒症的诊断性研究文献,检索数据库为Cochrane Library、Pub Med、EMBASE、维普中文科技期刊数据库、Medline、Web of knowledge、中国生物医学文献数据库、中国知网(CNKI)和万方数据库。检索时间为建库至2016年8月,按照QUADAS标准对纳入文献进行质量评估,使用Meta Disc1.4软件进行Meta分析,对其敏感度、特异度、诊断比值比进行汇总,行敏感性分析及异质性检验,绘制综合受试者工作特征曲线(SROC)。结果:初检到542篇文献,最终14篇文献符合纳入标准进入Meta分析。采用随机效应模型进行Meta分析,结果显示合并敏感度为0.72[95%CI(0.69,0.74)],特异度为0.85[95%CI(0.83,0.87)],阳性似然比为5.98[95%CI(3.79,9.43)],阴性似然比为0.23[95%CI(0.15,0.37)],诊断比值比为29.23[95%CI(14.79,57.77)]。SROC曲线下面积AUC=0.919 9(Q*=0.853 2)。结论:在早期新生儿脓毒症患者中,IL-6对患儿诊断脓毒症有较好的敏感度和特异度,即IL-6升高的患儿诊断为脓毒症的可能性较高,但在实际临床工作中仍需参考其他实验室相关检查及具体临床表现进行诊断。

Objective：To investigatethe early diagnostic value of interleukin-6 （IL-6） for sepsis in neonates. Methods：A comprehensive electronic search was performed to retrieve relevant studies on IL-6 in diagnosis of sepsis in Neonates. The data bases included Cochrane Library, PubMed, EMBASE, VIP database, Medline, Web of knowledge, Chinese BioMedicine Database, CNKI and Wanfang Database. The time range was from the initiation of the database to August 2016, and QUADAS items were used to evaluate the quality of the included studies. The pooled specificity, pooled sensitivity, negative likelihood ratio, positive likelihood ratio and summary receiver operating characteristic curve （SROC） were analyzed by the Meta-Disk 1.4 software. Finally, the sensitivity analysis and analysis for heterogeneity cause were performed.Results： Fourteen studies screened from 542 related articles were included in the review. The meta-analysis of DerSimonia-Laird showed that the pooled sensitivity was 0.72 [95% CI （0.69,0.74） ] and the pooled specificity was 0.85 [95% CI （0.83,0.87） ]. The positive likelihood ratio and negative likelihood ratio were 5.98 [95% CI （3.79,9.43） ] and 0.23 [95% CI （0.15,0.37） ], respectively. The diagnostic odds ratio was 29.23 [95% CI （14.79,57.77） ], overall area under the curve （AUC） of SROC curve was 0.9199 （Q＊=0.8532）. Conclusions： In the early sepsis, IL-6 has higher sensitivity and specificity for diagnosis of sepsis in neonates. IL-6 increases the probability for diagnosis of sepsis, but it needs to combine with clinical manifestations and other related laboratory tests for the diagnosis.