血清降钙素原对侵袭性念珠菌病鉴别诊断价值的meta分析

The value of serum procalcitonin in differential diagnosis of invasive candidiasis:a meta analysis

目的探讨降钙素原(procalcitonin,PCT)对侵袭性念珠菌病的鉴别诊断价值。方法计算机检索PubMed、Embase、Medline、Cochrane图书馆、中国知网和万方数据库,检索时限均为建库至2022年1月,收集PCT鉴别诊断侵袭性念珠菌病的前瞻性和回顾性队列研究和病例对照研究。应用RevMan5.3软件QUADAS-2风险评估工具对文献进行质量评价,Meta-Disc1.4软件判断原始数据是否存在阈值效应及异质性,Stata14.0软件进行meta分析、判断发表偏倚并绘制Deeks图。结果共纳入9篇文献,共943例患者。其中,念珠菌组259例,对照组684例。总灵敏度为0.86[95%置信区间(confidence interval,CI)(0.80,0.91)]、特异度为0.78[95%CI(0.70,0.84)]、阳性似然比为3.92[95%CI(2.77,5.55)]、阴性似然比为0.18[95%CI(0.12,0.27)]、受试者工作特征曲线的曲线下面积为0.90[95%CI(0.87,0.92)]、诊断比值比为19.75[95%CI(10.71,36.43)]。异质性检验结果显示研究间存在非阈值效应引起的异质性。亚组分析结果显示PCT<2 ng/mL的亚组异质性I2值明显下降,结果更稳定,灵敏度为0.86[95%CI(0.79,0.91)]、特异度为0.72[95%CI(0.63,0.80)]、受试者工作特征曲线的曲线下面积为0.87[95%CI(0.83,0.89)]。结论血清PCT鉴别诊断侵袭性念珠菌病有一定的准确性且具有阴性预测价值,但PCT只是辅助检测,鉴别诊断侵袭性念珠菌病需要结合临床特征和其他诊断指标综合判断。

Objective To explore the value of procalcitonin(PCT)in differential diagnosis of invasive candidiasis.Methods PubMed,Embase,Medline,Cochrane Library,China National Knowledge Infrastructure and Wanfang Data were searched for articles published from the dates of establishment of databases to January 2021.A prospective and retrospective cohort studies and a case-control studies of PCT in differential diagnosis of invasive candidiasis were collected.RevMan 5.3 software QUADAS-2 risk assessment tool was used to evaluate the quality of the literature.Meta-Disc 1.4 software was used to determine whether the original data had threshold effect and heterogeneity.Stata 14.0 software was used to analyze meta,judge publication bias and draw Deeks diagram.Results A total of9 articles and 943 patients were included.There were 259 cases in candida group and 684 cases in control group.The study showed that the total sensitivity was 0.86[95%confidence interval(CI)(0.80,0.91)],specificity was 0.78[95%CI(0.70,0.84)],positive likelihood ratio was 3.92[95%CI(2.77,5.55)],negative likelihood ratio was 0.18[95%CI(0.12,0.27)],the area under receiver operator characteristic curve was 0.90[95%CI(0.87,0.92)],diagnostic odds ratio was 19.75[95%CI(10.71,36.43)].The results of heterogeneity test showed that there was heterogeneity caused by non-threshold effect between studies.The results of subgroup analysis showed that the heterogeneity I2 value of PCT<2 ng/mL subgroup decreased significantly,and the result was more stable,with sensitivity.The results show that sensitivity was 0.86[95%CI(0.79,0.91)],specificity was 0.72[95%CI(0.63,0.80)],the area under receiver operator characteristic curve was 0.87[95%CI(0.83,0.89)].Conclusions Serum PCT in the differential diagnosis of invasive candidiasis has certain accuracy and negative predictive value.However,PCT is only an auxiliary test.The differential diagnosis of invasive candidiasis should be combined with clinical features and other diagnostic indexes.