脑脊液多重聚合酶链反应检测对社区获得性细菌性脑膜炎病原诊断价值Meta分析

Value of multiple polymerase chain reaction test in cerebrospinal fluid for pathogenie diagnosis of communily-acquired bacterial meningitis:a meta-analysis

目的系统评价脑脊液多重聚合酶链反应(mPCR)检测对社区获得性细菌性脑膜炎(CABM)病原诊断的诊断价值。方法2021年9月首都医科大学附属北京儿童医院感染内科按检索策略通过计算机检索万方、Sinomed、Pubmed、CochraneLibrary、Embase数据库,获得mPCR对CABM的诊断价值的相关文献,检索时间为建库至2021年9月。由2名研究者独立进行文献筛选、质量评价和数据提取。采用Stata11.0软件进行Meta分析,计算合并灵敏度、特异度、阳性似然比、阴性似然比和诊断优势比,绘制综合受试者工作特征(SROC)曲线,并计算曲线下面积(AUC)。根据研究类型、病原菌种类及患者群进行亚组分析,通过逐一剔除法进行敏感性分析,采用Deeks漏斗图法进行发表偏倚的评估。结果共检索出279篇文献,最终纳入19篇文献共计4679例患者。Meta分析结果显示,脑脊液mPCR检测可提升0.89%~49.51%的细菌培养病原阳性率,合并灵敏度和特异度分别为0.91(95%CI0.75~0.97)和0.88(95%CI0.78~0.94),阳性似然比和阴性似然比为7.7(95%CI 3.9~15.2)和0.11(95%CI0.04~0.31),诊断优势比为72(95%CI 18~295),AUC为0.95(95%CI0.93~0.97)。亚组分析结果显示脑脊液mPCR检测对CABM三种常见病原体(肺炎链球菌、脑膜炎奈瑟菌和流感嗜血杆菌)及儿童人群均具有较高的诊断效能。敏感性分析表明本研究结果稳定可信。结论脑脊液mPCR检测对CABM病原诊断具有较高的诊断效能,可作为CABM病原诊断的辅助方法。

Objective To systematically evaluate the value of multiple polymerase chain reaction(mPCR)in cerebrospinal fluid for pathogenic diagnosis of community-acquired bacterial meningitis(CABM).Methods Wanfang,Sinomed,Pubmed,Cochrane Library and Embase databases were searched from the establishment of the database to September 2021 according to the retrieval strategy.Two researchers conducted literature screening,quality assessment and data extraction independently.Meta-analysis was performed using Statall.0 to calculate the combined sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and diagnostic odds ratio.The subject receiver operating characteristic(SROC)curve was drawn and the area under the curve(AUC)was alsocalculated.Subgroupanalysis was performed according to study type,pathogen species and affected population.Sensitivity analysis was performed by one-by-one exclusion method,and publication bias was evaluated by Deek's funnel plot method.ResultsA total of 279 articles were retrieved,and 4679 cases of 19 articles were finally included according to exclusion and inclusion criteria.Metaanalysis showed that mPCR in CSF could increase the positive rate of bacterial culture pathogens by 0.89%~49.51%.The combined sensitivity and specificity of mPCR in CSF were 0.91[95%CI 0.75-0.97]and 0.88[95%CI 0.78-0.94],and the positive and negative likelihood ratios were 7.7[95%CI 3.9-15.2]and 0.11[95%CI 0.04-0.31],respectively.The diagnostic odds ratio was 72[95%CI 18-295]and the AUC was 0.95[95%CI 0.93-0.97].Subgroup analysis showed that mPCR detection had high diagnostic efficiency for three common pathogens of CABM(Streptococcus pneumoniae,Haemophilus and Meningococcal)and children.Sensitivity analysis showed that the results of this study were stable and credible.Conclusion The mPCR test in cerebrospinal fluid has high diagnostic efficiency in the diagnosis of CABM,and can be used as an auxiliary method for the pathogenic diagnosis of CABM.