血清降钙素原对成人颅内感染诊断价值的Meta分析

Meta analysis on diagnostic value of serum procalcitonin for intracranial infection in adults

目的探讨血清降钙素原(PCT)对成人颅内感染的诊断价值。方法采用计算机检索英文数据库(PubMed、The Cochrane Library)、中文数据库(中国知网、万方期刊数据库及维普中文科技期刊数据库)从建库至2017年6月期间血清PCT对成人颅内感染诊断研究的文献。按照纳入与排除标准筛选文献,应用RevMan5.3统计软件提供的QUADAS-2风险评估工具对纳入文献进行质量评估,应用Meta-Disc 1.4软件进行Meta分析,应用Stata 13.0软件判断发表偏移并绘制Deeks图。结果最终纳入9篇文献,共1 446例患者。总灵敏度0.86(95%CI:0.82～0.89)、特异度0.91(95%CI:0.89～0.92)、阳性似然比6.50(95%CI:4.15～10.18)、阴性似然比0.15(95%CI:0.07～0.33)、诊断比值比44.66(95%CI:16.26～122.66)、SROC AUC0.9357和Q~*指数0.8720。异质性检验结果显示,各研究间存在异质性。亚组分析结果提示,当PCT阳性界值为0.1～0.5 ng/mL时SROC AUC(0.9692)和Q~*值(0.9185)最大。结论血清PCT对成人颅内感染有较高的诊断价值,可用于颅内感染的鉴别诊断。

Objective To evaluate the value of serum procalcitonin(PCT)in diagnosing intracranial infection in adults.Methods Literatures about serum PCT for diagnosing intracranial infection in adults were retrieved from English database(PubMed,The Cochrane Library)and Chinese database(China National Knowledge Infrastructure[CNKI],Wanfang Database,and VIP Database)from establishment of database to June 2017.According to inclusion and exclusion criteria,QUADAS-2 risk assessment tool provided by RevMan 5.3 statistical software was used to evaluate the quality of included literatures,Meta-Disc 1.4 software was used for Meta analysis,Stata 13.0 software was used to judge the publication bias and draw Deeks diagram.Results A total of 9 articles and 1 446 patients were included in the study.Total sensitivity was 0.86(95%CI:0.82-0.89),specificity 0.91(95%CI:0.89-0.92),positive likelihood ratio 6.50(95%CI:4.15-10.18),negative likelihood ratio 0.15(95%CI:0.07-0.33),diagnostic odds ratio 44.66(95%CI:16.26-122.66),SROC AUC 0.9357,and Q*index 0.8720.Hete-rogeneity test showed there was heterogeneity among studies.Subgroup analysis showed that SROC AUC(0.9692)and Q*value(0.9185)were the highest when PCT positive threshold was 0.1-0.5 ng/mL.Conclusion Serum PCT has high diagnostic value for intracranial infection in adults,and can be used for differentiating diagnosis of intracranial infection.