脐血降钙素原对新生儿宫内感染诊断价值的Meta分析

The clinical value of cord-blood procalcitonin for the diagnosis of neonatal intrauterine bacterial infection:a meta-analysis

目的探讨脐血降钙素原(procalcitonin,PCT)对新生儿宫内感染的诊断价值.方法检索Embase、Cochrane library、PubMed、Web of Science、中国知网、万方数据库和中国生物医学文献数据库自建库至2018年12月31日发表的关于评价或探讨脐血PCT对新生儿宫内感染诊断价值的文献,提取纳入研究的研究背景、设计信息和诊断参数信息.数据分析应用Meta-Disc1.4统计软件,检验各研究间异质性,并根据异质性结果选择相应的效应模型.对所有研究予以加权定量合并,计算敏感度、特异度及其95%置信区间.绘制汇总受试者工作特征曲线,并计算曲线下面积,最后进行敏感度分析和比较.结果共纳入9篇文献,3571例新生儿,分别来自法国、波兰、澳大利亚、捷克和中国.6篇诊断宫内感染的研究中脐血PCT的汇总敏感度、特异度和受试者工作特征曲线下面积分别为73.7%、82.6%和0.839;3篇诊断早发型败血症的研究中脐血PCT汇总敏感度、特异度和受试者工作特征曲线下面积分别为92.3%、97.2%和0.987.脐血PCT检测敏感度分析表明,疾病严重程度和PCT检测阈值不同是各研究间产生异质性的原因.结论脐血PCT对新生儿宫内感染具有一定诊断价值,对新生儿早发型败血症具有极高的诊断价值.

Objective To study the clinical value of cord-blood procalcitonin (PCT) for the diagnosis of neonatal intrauterine bacterial infection. Method Embase, Cochrane library, PubMed, Wanfang Database, CNKI Database and Chinese Biomedical Literature Database were searched from the establishment date of the databases to the end of 2018. Articles involving PCT and intrauterine infection were enrolled. The research background, design information and diagnostic parameters were extracted and analysed using Meta-Disc 1.4 software. Heterogeneity of the data were studied and corresponding effect models were selected according to the heterogeneity results. Data from all studies were weighted and quantitatively combined. Summary receiver operating curve (SROC) were drawn and the area under the curve (AUC) were calculated. Finally, sensitivity analysis were carried out. Result A total of 318 articles, including 242 in foreign languages and 66 in Chinese, were retrieved. According to the inclusion criteria, 9 articles were finally obtained. A total of 3 571 newborns from five countries (France, Poland, Australia, Czech and China) were included. In the 9 articles, cord-blood PCT was used to diagnose intrauterine infection in six articles. The pooled sensitivity, specificity and SROC AUC were 73.7%, 82.6% and 0.839. For the rest three articles in which cord-blood PCT was used to diagnose early-onset sepsis, the pooled sensitivity, specificity and SROC AUC were 92.3%, 97.2% and 0.987, respectively. The sensitivity analysis of cord-blood PCT detection showed that disease severities and the differences of PCT detection threshold caused the heterogeneity. Conclusion Cord-blood PCT has diagnostic value for intrauterine infection of neonates and for early-onset sepsis of neonates.