论文部分内容阅读
目的评价降钙素原(PCT)和血浆可溶性髓样细胞触发受体1(s TREM-1)对呼吸机相关性肺炎(VAP)的诊断价值。方法系统检索Pub Med、Ovid SP(EMBASE)、Cochrane Library、clinicaltrials.gov、EBSCO、CBM、CNKI和中国万方数据库,检索截止时间为2013年12月。使用QUADAS量表对纳入文献的质量进行评价。通过Meta-disc软件对PCT和s TREM-1诊断VAP的敏感性、特异性、阳性似然比、阴性似然比、诊断比值比分别进行合并,并计算sROC曲线下面积(AUC),两者AUC的比较使用Z检验,并根据贝叶斯理论计算相应的验后概率。结果最终31篇文献纳入研究,其中PCT文献20篇,s TREM-1文献11篇。合并后结果提示,PCT诊断VAP的敏感性和特异性分别为0.78和0.74,诊断比值比为15.21,AUC为0.868。s TREM-1诊断VAP敏感性和特异性为0.88和0.80,诊断比值比为30.28,AUC为0.919。两者AUC比较差异无统计学意义(P=0.25)。结论结合贝叶斯理论,s TREM-1与PCT相比对VAP的诊断有较高的价值,但是两者均无法作为单独的手段用于诊断或排除VAP。
Objective To evaluate the diagnostic value of procalcitonin (PCT) and plasma soluble myeloid cell trigger receptor 1 (s TREM-1) in patients with ventilator-associated pneumonia (VAP). Methods PubMed, Ovid SP (EMBASE), Cochrane Library, clinicaltrials.gov, EBSCO, CBM, CNKI and China Wanfang Database were searched. The deadline for the search was December 2013. The quality of the included documents was evaluated using the QUADAS scale. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio for the PCT and s TREM-1 diagnostic VAPs were individually combined by Meta-disc software and the area under the sROC curve (AUC) was calculated, both The AUC was compared using the Z test and the corresponding posterior probability was calculated based on Bayesian theory. Results The final 31 articles were included in the study, of which 20 were PCT and 11 were TREM-1. The combined results suggest that the sensitivity and specificity of PCT in the diagnosis of VAP were 0.78 and 0.74 respectively, the diagnostic odds ratio was 15.21 and the AUC was 0.868. The sensitivity and specificity of TREM-1 in diagnosing VAP were 0.88 and 0.80, the diagnostic odds ratio was 30.28 and the AUC was 0.919. The difference between the two AUC was not statistically significant (P = 0.25). Conclusion According to Bayesian theory, s TREM-1 is valuable in the diagnosis of VAP compared with PCT, but neither can be used as a separate tool for the diagnosis or exclusion of VAP.