血清降钙素原对新生儿败血症诊断价值的Meta分析

Meta-analysis on procalcitonin as a marker in the diagnosis of neonatal sepsis

目的:运用Meta分析法探讨血清降钙素原(PCT)诊断新生儿败血症的意义,分析不同研究间异质性,初步探寻影响异质性的有关因素,为临床医生诊断检测指标提供参考依据。方法:检索数据库为Pub Med、EMBASE,收集2010年1月~2016年6月关于PCT诊断新生儿败血症试验性的文献。根据Meta分析要求对检索到的原始文献进行质量评估,运用Med Disc软件进行诊断试验Meta分析;Revman软件制作文献质量评价图。结果:符合纳入标准的文献共12篇。灵敏度和特异度合并值分别为0.80(0.77~0.83)、0.74(0.71~0.77),诊断OR值为12.33(8.84~17.2),AUC为0.86。另外,我们发现纳入的研究间存在异质性,阈值效应检验为阴性(r_s=0.358,P=0.208),表明异质性来源于其他非阈值因素。结论:PCT诊断新生儿败血症灵敏度和特异度较高且不同研究间存在差异,有待进一步研究影响PCT诊断新生儿败血症准确性的其他因素。

Objective：To assess the accuracy of procalcitonin（PCT） test for diagnosing neonatal sepsis through quantifying the heterogeneity in meta-analysis in different studies for sufficient sensitivity and specificity to establish the diagnosis.Methods： Publications involved in the PCT tests for diagnosis of neonatal sepsis were retrieved from PubMed and EMBASE between January 2010 and June 2016.Then the original studies were quantified with software MedDisc for meta-analysis,and softward Revman was used map the systematic evaluation.Results： A total of 12 eligible studies were included in the analysis.Meta-analysis indicated that sensitivity and specificity of PCT for diagnosing neonatal sepsis were 0.80（0.77-0.83） and 0.74（0.71-0.77）,respectively,and the diagnostic OR was 12.33（8.84-17.2） and AUC,0.86.Additionally,heterogeneity was found between studies,and PCT thresholds for diagnosis of the sepsis was negative（rs =0.358,P=0.358）,suggesting that the heterogeneity was associated with other non-thresholds.Conclusion： PCT test has better sensitivity and specificity for the diagnosis of neonatal sepsis.However,the accuracy varies among studies,and the factors affecting the diagnostic accuracy in neonatal sepsis remains to be determined.