C反应蛋白对慢性阻塞性肺疾病急性加重患者细菌感染诊断准确性的Meta分析

Diagnostic accuracy of C-reactive protein for bacterial infections in acute exacerbation of chronic obstructive pulmonary disease:A meta-analysis

目的:通过Meta分析的方法探讨C反应蛋白(CRP)对慢性阻塞性肺疾病急性加重(AECOPD)细菌感染的诊断准确性。方法:计算机检索Web of Science、PubMed、Cochrane图书馆、EMBASE、万方数据库、中国知网和中国生物医学文献数据库,获得关于CRP对AECOPD细菌感染诊断价值的文献,按照诊断准确性质量评价工具QUADAS-2标准对纳入文献进行质量评估。使用Stata 12.0软件进行Meta分析,对各研究的灵敏度、特异度进行汇总,并进行异质性检验分析,绘制综合受试者工作特征曲线(SROC)、计算曲线下面积(AUC),绘制漏斗图判断发表偏倚。结果:初检到665篇文献,20篇文献符合标准(9篇英文,11篇中文),Meta分析结果显示CRP诊断细菌感染性AECOPD的汇总灵敏度和特异度分别为0.84(95%CI0.77~0.90)和0.76(95%CI0.67~0.82)。SROC的AUC为0.87(95%CI0.83~0.89)。结论:CRP鉴别AECOPD细菌感染与非细菌感染的准确性高,具有较高的灵敏度和特异度。

Objective:The clinical diagnostic accuracy of C-reactive protein(CRP)for bacterial infections in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is still controversial.This study evaluated its accuracy through Meta-analysis.Methods:Studies on the diagnostic value of CRP for bacterial infections in AECOPD were searched form Web of Science,PubMed,Cochrane library,EMBASE,WANFANG DATA,CNKI and China Biology Medicine disc.The included studies were evaluated according to QUADAS-2,the diagnostic accuracy quality assessment tool.Stata 12.0 software was used for Meta analyses to summarize the sensitivity and the specificity of the included studies,and the heterogeneity test was conducted.The summary receiver operating characteristic curves(SROC)was drawn and the area under the curve(AUC)was calculated,and the funnel plot was drawn to determine publication bias.Results:Totally 665 studies were initially identified,20 of which met the inclusion criteria(9 in English and 11 in Chinese).Meta-analysis results showed that the summary sensitivity and specificity of CRP in diagnosing bacterial infections in AECOPD were 0.84,95%CI(0.77~0.90)and 0.76,95%CI(0.67-0.82),respectively.The AUC of SROC was 0.87,95%CI(0.83-0.89).Conclusion:CRP has high accuracy,sensitivity and specificity in distinguishing AECOPD bacterial infections from non-bacterial infection.