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目的探讨降钙素原(PCT)对儿童细菌性脑膜炎的诊断价值。方法采用计算机检索获得PCT对儿童细菌性脑膜炎的诊断性研究文献,检索时间为建库至2013年7月,按照QUADAS标准评价纳入文献质量。采用Meta-Disc 1.4软件进行Meta分析,对敏感度、特异度、阳性似然比、阴性似然比进行汇总和异质性检验,绘制综合受试者特征曲线(SROC),行敏感性分析和异质性原因分析。使用Stata 12.0软件判断发表偏移并绘制漏斗图。结果 12篇文献进入Meta分析(中文5篇,英文7篇)。①汇总敏感度0.95(95%CI:0.92~0.97),特异度0.89(95%CI:0.86~0.92),阳性似然比11.09(95%CI:5.73~21.49),阴性似然比0.07(95%CI:0.05~0.11),诊断比值比122.01(95%CI:65.08~228.75),SROC曲线下面积(AUC)0.977 7,Q*指数0.933。②分别剔除样本量<50文献、中文文献和回顾性研究文献的敏感性分析显示,上述诊断参数的95%CI与原数据有较大重叠。③特异度、阳性似然比的文献间存在显著的异质性,研究地域、PCT检测方法和细菌性脑膜炎诊断标准可能不是异质性产生的原因。④以PCT 5μg·L-1界值诊断儿童细菌性脑膜炎的敏感度、特异度,SROC AUC和Q*指数最大。结论 PCT在鉴别诊断儿童细菌性脑膜炎与病毒性脑膜炎中有较高的敏感度和特异度,但各研究间存在异质性,使用PCT鉴别诊断儿童细菌性脑膜炎仍需结合具体的临床情况。
Objective To investigate the value of procalcitonin (PCT) in the diagnosis of bacterial meningitis in children. Methods The computerized literature retrieval of bacterial bacterial meningitis in children diagnostic literature, search time for the construction of the library to July 2013, according to QUADAS standard evaluation of the quality of the included literature. Meta-analysis was performed with Meta-Disc 1.4 software. The sensitivities, specificities, positive likelihood ratios and negative likelihood ratios were summarized and heterogeneity tested. The comprehensive characteristics of subjects (SROC), sensitivity analysis and Heterogeneity analysis. Use Stata 12.0 software to determine the publication offset and plot the funnel. Results 12 articles entered Meta analysis (5 in Chinese and 7 in English). ① The pooled sensitivities were 0.95 (95% CI: 0.92-0.97), specificity 0.89 (95% CI: 0.86-0.92), positive likelihood ratio 11.09 (95% CI: 5.73-21.49) and negative likelihood ratio 0.07 % CI: 0.05-0.11). The diagnostic odds ratio 122.01 (95% CI: 65.08-228.75), the area under the curve of SROC (AUC) 0.9777, and the Q * index 0.933. (2) Sensitivity analysis of culling samples <50, Chinese and retrospective study respectively showed that 95% CI of the above diagnostic parameters overlap with the original data. ③ Specificity, positive likelihood ratio of the literature there is significant heterogeneity between the study area, PCT test methods and bacterial meningitis diagnostic criteria may not be the cause of heterogeneity. ④ The sensitivity, specificity and SROC AUC and Q * index of diagnosis of bacterial bacterial meningitis in children with PCT 5μg · L-1 cutoff were the highest. Conclusions PCT has high sensitivity and specificity in the differential diagnosis of bacterial meningitis and viral meningitis in children, but there is heterogeneity between the studies. PCT differential diagnosis of bacterial bacterial meningitis in children still needs to be combined with specific clinical Happening.