尿白介素18对儿童急性肾损伤诊断价值的meta分析

Diagnostic value of urinary interleukin 18 in children with acute kidney injury:a meta-analysis

目的评价尿白介素18(IL-18)用于早期诊断儿童急性肾损伤(AKI)的价值。方法计算机检索Medline、EMBASE、Cochrane图书馆、PubMed、Web of Science、Google Scholar、中国知网、维普及万方数据库等,检索时间为从建库至2018年3月,获得尿IL-18诊断儿童AKI的文献。采用诊断准确性研究的质量评估方法2(QUADAS-2)对纳入文献进行质量评价,应用Meta-Disc 1.4和STATA 12.0软件进行数据分析。结果共纳入9项研究,包括1 214例患儿。Meta分析结果显示,尿IL-18诊断儿童AKI的合并灵敏度为0.74(95%CI:0.69～0.79),合并特异度为0.66(95%CI:0.63～0.69),合并阳性似然比为2. 30(95%CI:1. 80～2. 92),合并阴性似然比为0. 42(95%CI:0. 31～0. 56),合并诊断比值比为6. 50(95%CI:4.20～10.07),综合受试者工作特征曲线下面积为0.779(S.E.=0.025)。结论尿IL-18是早期预测儿童AKI的有价值的生物标志物,其诊断准确性中等。

Objective To explore the value of urinary interleukin 18(IL-18)in the early diagnosis of acute kidney injury(AKI)in children.Method Medline,EMBASE,Cochrane Library,PubMed,Web of Science,Google Scholar,China National Knowledge Infrastructure,VIP and WanFang Database were searched and retrieved.The literature of urinary IL-18 for the diagnosis of AKI in children were obtained from inception to March 2018.Quality Assessment of Diagnostic Accuracy Studies-2(QUADAS-2)was used to evaluate the quality of included literature.Meta-Disc 1.4 and STATA 12.0 software were used to analyze the data.Results A total of 9 studies were included,including 1214 children.Across all settings,the pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and diagnostic odds ratio for urinary IL-18 level to predict AKI were 0.74(95%CI:0.69~0.79),0.66(95%CI:0.63~0.69),2.30(95%CI:1.80~2.92),0.42(95%CI:0.31~0.56)and 6.50(95%CI:4.20~10.07),respectively,and the area under the summary receiver operating characteristic curve was 0.779(S.E.=0.025).Conclusion Urinary IL-18 is a valuable biomarker for the early prediction of childhood AKI with moderate diagnostic accuracy.