肝素结合蛋白对成人脓毒症诊断价值的Meta分析

Value of heparin-binding protein in diagnosis of sepsis in adult patients:a Meta-analysis

目的 系统评价肝素结合蛋白(HBP)在成人脓毒症诊断中的价值.方法 检索美国国立医学图书馆PubMed数据库、荷兰医学文摘Embase数据库、Cochrane临床试验数据库、万方数据库、中国知网、维普数据库收录的自建库至2019年7月发表的有关HBP诊断成人脓毒症的中、英文文献.由2位研究者独立提取相关资料;采用诊断准确性研究的质量评价工具QUADAS-2对文献进行质量评价;用Meta-Disc 1.4和STATA 12.0软件进行Meta分析,计算合并的敏感度、特异度、阳性似然比(PLR)、阴性似然比(NLR)和诊断优势比(DOR)等指标,绘制拟合受试者工作特征曲线(SROC)并计算曲线下面积(AUC);采用Deek检验法检测发表偏倚.结果 最终纳入10项研究共1 884例患者,文献质量相对适中.所有研究均采用酶联免疫吸附试验(ELISA)检测血浆中HBP水平.Meta分析结果显示,各研究间存在异质性,随机效应模型分析显示,合并敏感度、合并特异度、合并PLR、合并NLR和合并DOR分别为0.80 〔95%可信区间(95%CI)为0.77~0.83〕、0.80(95%CI为0.78~0.82)、3.96(95%CI为2.45~6.41)、0.28(95%CI为0.20~0.39)、14.63(95%CI为6.83~31.30);合并AUC为0.86,Cochran-Q=0.79.为了探索异质性的潜在来源,对疾病严重程度、脓毒症诊断标准和地区进行亚组分析,结果显示无方法学上的共变量影响HBP的诊断准确性,表明仍存在不能解释的异质性.此外,通过逐个剔除各项研究进行敏感度分析,未发现异常值研究,结果相对稳定可靠.Deek检验显示纳入文献不存在发表偏倚.结论 HBP对成人脓毒症具有较好的诊断价值,但仍需进一步扩大样本量进行验证.

Objective To evaluate the application of heparin-binding protein(HBP)in diagnosis of sepsis in adult patients.Methods An extensive search for the Chinese and English literatures from the PubMed,Embase,the Cochrane Library,Wanfang data,CNKI and VIP up to July 2019 was performed.The articles regarding HBP for the diagnosing of sepsis in adult patients were enrolled.Two researchers independently extracted related literature.The quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies(QUADAS-2)tool.Meta-Disc 1.4 and STATA 12.0 were used for Meta-analysis.The pooled sensitivity,specificity,positive likelihood ratio(PLR),negative likelihood ratio(NLR),and diagnostic odds ratio(DOR)were calculated.Summary receiver operating characteristic(SROC)curves and area under the curve(AUC)were used to evaluate the diagnostic performance of HBP for sepsis.Deek funnel plot was used to detect publication bias.Results A total of 10 studies with 1884 patients were included in this Meta-analysis.The quality of the literature was relatively moderate.HBP in plasma were detected by enzyme linked immunosorbent assay(ELISA)in all studies.The studies showed substantial heterogeneity,and random effect model was used for Meta-analysis.The pooled sensitivity,specificity,PLR,NLR,and DOR were 0.80[95%confidence interval(95%CI)was 0.77-0.83],0.80(95%CI was 0.78-0.82),3.96(95%CI was 2.45-6.41),0.28(95%CI was 0.20-0.39)and 14.63(95%CI was 6.83-31.30)respectively.The pooled AUC was 0.86 and the Cochran-Q was 0.79.To explore the potential sources of heterogeneity,subgroup analyses were performed based on the severity of the disease,diagnostic criteria and region.However,the results indicated that no methodological covariates affected the diagnostic accuracy of HBP,indicating that there was still unexplained heterogeneity.In addition,the sensitivity analysis by removing individual studies were performed.No outlier study was identified and the results were relatively stable and reliable.Deek funnel plot showed little publication bias.Conclusions There is preferable value of HBP for diagnosis of sepsis in adult patients.However,it needs to be further confirmed by large multicenter studies.