脑钠肽/N端脑钠肽原预测早产儿hsPDA的Meta分析

BNP/NT-proBNP for the prediction of hemodynamically significant patent ductus arteriosus in premature infants:a Meta-analysis

目的应用Meta分析的方法评价脑钠肽/N-端脑钠肽原(BNP/NT-proBNP)在预测早产儿血流动力学改变显著的动脉导管未闭(hsPDA)中的价值。方法计算机检索PubMed、EMbase、Cochrane Library、Web of Knowledge、Ovid、CBM、CNKI、WanFang Data和维普数据库,检索时间均为建库至2018年12月,并手工检索相关杂志以及纳入文献的参考文献。分别由2名评价员按照纳入与排除标准独立选择相关文献、根据QUADAS2质量评估标准评估文献质量以及相互核对、统一意见后,采用RevMan5.2和MetaDisc1.4软件进行Meta分析,对纳入文献进行异质性检验和效应量加权定量合并,计算汇总灵敏度、特异度、诊断比值比、阳性似然比、阴性似然比及其95%置信区间(95%CI),绘制汇总受试者工作特征曲线(SROC)并计算曲线下面积(AUC)。结果共纳入7篇文献,合计病例370例。Meta分析结果显示:BNP或NT-proBNP预测早产儿hsPDA发生的诊断比值比(DOR)为105.96[95%CI(47.81,234.82)];汇总灵敏度为0.94[95%CI(0.89,0.98)],汇总特异度为0.91[95%CI(0.87,0.94)],汇总阳性似然比为9.58[95%CI(6.52,14.06)],汇总阴性似然比为0.08[95%CI(0.04,0.14)];SROC曲线的AUC为0.9417(Q值为0.8796)。结论BNP或NT-proBNP水平升高与早产儿hsPDA发生具有显著相关性,可以预测早产儿hsPDA的发生。

Objective To systematically evaluate the application of brain natriuretic peptide/N terminal proBrain natriuretic peptide(BNP/NT-proBNP)in the prediction of hemodynamically significant patent ductus arteriosus(hsPDA)in premature infants.Methods Related literatures were retrieved from online databases including PubMed,EMbase,Cochrane Library,Web of Knowledge,Ovid,CBM,WanFang Data,CNKI and VIP Data since their establishment till December 2018,and relevant periodicals and references of the included literature were also manually retrieved.Two reviewers independently selected relevant literature according to the inclusion and exclusion criteria and evaluated the quality of the literature according to the QUADAS2.After the cross-checking and reaching of a consensus,meta-analysis was conducted by RevMan 5.2 and MetaDisc1.4,the heterogeneity test was conducted,the effect size was subject to weighted quantitative combination,the pooled sensitivity,specificity,diagnostic odds ratio,positive likelihood ratio,negative likelihood ratio as well as 95%confidence interval(95%CI)were calculated,the total SROC was drawn and the area under the curve(AUC)was calculated.Results Seven articles with a total of 370 cases were included.The Meta-analysis results showed that the DOR of BNP/NTproBNP for prediction of hsPDA in preterm infants was 105.96[95%CI(47.81,234.82)],the pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,and the AUC were 0.94[95%CI(0.89,0.98)],0.91[95%CI(0.87,0.94)],9.58[95%CI(6.52,14.06)],0.08[95%CI(0.04,0.14)]and 0.9417(Q value of 0.8796),respectively.Conclusion Elevated BNP/NT-proBNP level is significantly correlated to the occurrence of hsPDA in preterm infants.BNP/NT-proBNP can predict the occurrence of hsPDA in preterm infants.