脑脊液PCR检测对中枢神经系统侵袭性曲霉菌感染的诊断价值——系统评价和双变量Meta分析

Diagnostic Value of Cerebrospinal Fluid PCR Detection for Invasive Aspergillosis in the Central Nervous System:Systematic Review and Bivariate Meta-analysis

目的系统评价脑脊液多聚酶链反应(PCR)对中枢神经系统侵袭性曲霉菌感染的诊断价值。方法计算机检索PubMed、The Cochrane Library、EMbase、CNKI、WanFang Data、CBM和VIP,查找评估PCR对中枢神经系统侵袭性曲霉菌感染诊断价值的相关研究,检索时限均为从建库至2015年1月10日。由两位评价者按照纳入与排除标准独立筛选文献、提取资料并评价纳入研究的方法学质量后,采用Stata 12.0软件统计并Meta分析,评估异质性及发表偏倚。结果最终纳入8个研究,共130例病人,确诊/可信病人数为27例(20.8%)。针对3篇病例对照及1篇队列研究的Meta分析结果显示:敏感度(Sen)、特异度(Spe)、阳性似然比(+LR)、阴性似然比(-LR)、诊断比值比(DOR)、ROC曲线下面积(AUC)分别为0.984[95%CI(0.796,0.992)]、0.930[95%CI(0.837,0.971)]、14.09[95%CI(5.87,33.82)]、0.016[95%CI(0.001,0.843)]、847[95%CI(16,4536)]、0.99[95%CI(0.97,0.99)]。但有一定的异质性(I^2=37%)和发表偏倚(P=0.095)存在。脑脊液PCR阳性率显著高于脑脊液GM检测(P=0.018)和血PCR检测(P=0.02)。结论脑脊液PCR对中枢神经系统侵袭性曲霉菌感染有较高的诊断价值。但PCR检测方法学上存在异质性,发表偏倚可能高估PCR方法的诊断价值,上述结论仍需谨慎看待。

Objective Systematic review about diagnostic value of cerebrospinal fluid PCR detection for invasive aspergillosis in the central nervous system(CNS).Methods Computer retrieval of PubMed,The Cochrane Library,EMbase,CNKI,Wan Fang Data,CBM and VIP was conducted.Studies published from initiation of the databases until January 10,2015,assessing diagnostic performance of CSF PCR detection for invasive aspergillosis in the central nervous system were searched.Two reviewers independently searched literature on the grounds of inclusion and exclusion standards,extracted information and evaluated methodological quality of included studies.statistical calculation and meta-analysis were conducted via Stata 12.0software and heterogeneity and publication bias were assessed.Results Totally eight studies were enrolled,with proven/probable 27 cases(20.8%)in 130 patients.Meta-analysis based on3 case-control studies and1 cohort study showed:sensitivity(Sen),specific(Spe),positive likelihood ratio(+ LR),negative likelihood ratio(-LR)and diagnostic odds ratio(DOR),the area under the ROC curve(AUC)were 0.984[95% CI(0.796,0.992)],0.930 [95% CI(0.837,0.971)],14.09 [95% CI(5.87,33.82)],0.016 [95% CI(0.001,0.843)]and 847 [95% CI(16,453 6)],0.99[95% CI(0.97,0.99)],respectively.But there were moderate heterogeneity(I 2= 37%)and publication bias(P =0.095).PCR positive rate in CSF was significantly higher than that of GM test in CSF(P =0.018)and blood PCR detection(P =0.02).ConclusionPCR test in CSF for invasive aspergillosis of the central nervous system has high diagnostic value.However,due to methodological heterogeneity of PCR detection and possibly overestimated diagnostic performance of PCR by publication bias,aforementioned conclusion must be drawn conscientiously.