中性粒细胞/淋巴细胞比值对子痫前期诊断价值的Meta分析

Diagnostic value of neutrophil-lymphocyte ratio in pre-eclampsia:a systematic review and meta-analysis

目的系统评价中性粒细胞/淋巴细胞比值(NLR)对子痫前期的诊断价值。方法在PubMed、The Cochrane Library、EMbase、中国知网(CNKI)、万方医学网、维普(VIP)、中国生物医学文献数据库(CBM)等数据库检索,时限从建库至2018年5月20日的相关文献。采用Meta-disc 1.4和Stata 12.0软件进行敏感性、特异性及其他指标的合并,分析NLR对子痫前期的诊断价值,Meta回归进行异质性检验。结果有7篇文献纳入研究,合并后的敏感性和特异性为0.74(95%CI:0.71,0.76)和0.64(95%CI:0.61,0.68),阳性似然比1.96(95%CI:1.79,2.16),阴性似然比0.43(95%CI:0.38,0.47),诊断比值比4.68(95%CI:3.93,5.58),曲线下面积(AUC)为0.82。Meta回归显示样本量是异质性的主要来源。Deeks漏斗图示该研究发表偏倚差异无统计学意义(P>0.05)。结论 NLR作为子痫前期的诊断标志物具有一定的敏感性,但是特异性不高。未来需要大量前瞻性研究来验证单独使用NLR或者联合其他标志物作为子痫前期诊断的潜在适用性。

Objective To evaluate the potential diagnostic value of neutrophil/lymphocyte ratio(NLR) in preeclampsia. Methods We searched PubMed, Embase, Cochrane Library, the Chinese National Knowledge Infrastructure(CNKI) databases, Wanfang data, VIP database and China biomedical literature database systematically for relevant literatures up to May 20, 2018. All analyses were conducted using Meta-DiSc 1.4 and Stata 12.0 software. Sensitivity, specificity and other measures of accuracy of NLR for the diagnosis of pre-eclampsia were pooled. Metaregression was performed to identify the sources of heterogeneity. Results This meta-analysis included a total of 7 studies. The overall sensitivity and specificity were 0.74(95% CI: 0.71, 0.76) and 0.64(95% CI: 0.61, 0.68);positive likelihood ratio was 1.96(95% CI: 1.79, 2.16), and negative likelihood ratio was 0.43(95% CI: 0.38, 0.47);diagnostic odds ratio was 4.68(95% CI: 3.93, 5.58);and area under the curve was 0.82. Meta-regression showed that sample size was the main source of heterogeneity. There was no statistical significance for the evaluation of publication bias(P>0.05). Conclusions Current evidence suggests that the diagnostic accuracy of NLR has unsatisfactory specificity but acceptable sensitivity for diagnosis of preeclampsia. Further large-scale prospective studies are required to validate the potential applicability of using NLR alone or combination with other markers as preeclampsia diagnostic biomarker.