摘要
目的探讨降钙素原(PCT)对新生儿脓毒症的诊断价值。方法检索Cochrane图书馆、PubMed、Ovid、Springer数据库、中国期刊全文数据库、万方数据库和中国生物医学文献数据库(1990年1月至2009年10月)中的文献,按照诊断试验的纳入标准筛选文献,提取纳入研究的特征信息(研究背景、设计信息和诊断参数信息)。数据分析采用Meta-DiSc1.4和SPSS12.0软件,检验异质性,并根据异质性结果选择相应的效应模型。对所有研究予以加权定量合并,计算敏感度、特异度及其95%CI。绘制汇总受试者工作特征(SROC)曲线,并计算曲线下面积(AUC),最后进行敏感度分析和不同组间敏感度比较。结果共检索出相关英文文献446篇,中文文献98篇,其他语种文献21篇。阅读标题和摘要,按照纳入标准,最终获取文献33篇(英文文献18篇,中文文献11篇,其他语种文献4篇),入选新生儿3599例。3篇文献新生儿出生时检测脐血PCT水平临床诊断早发型脓毒症,汇总敏感度、特异度和SROCAUC分别为77.7%、82.8%和0.8337;8篇文献新生儿出生后至12h检测血清PCT水平临床诊断早发型脓毒症,汇总敏感度、特异度和SROCAUC分别为76.7%、87.1%和0.8965;4篇文献新生儿出生后12～24h检测血清PCT水平临床诊断早发型脓毒症,汇总敏感度、特异度和SROCAUC分别为76.6%、88.5%和0.8844;6篇文献新生儿出生后24～48h检测血清PCT水平临床诊断早发型脓毒症,汇总敏感度、特异度和SROCAUC分别为69.8%、88.2%和0.8947;15篇文献新生儿出生后≥72h检测血清PCT水平临床诊断晚发型脓毒症,汇总敏感度、特异度和SROCAUC分别为79.0%、92.3%和0.9632;15篇文献新生儿出生后≥72h检测血清PCT水平确诊晚发型脓毒症,汇总敏感度、特异度和SROCAUC分别为84.5%、80.9%和0.9345。PCT检测敏感度分析表明,国家、研究人群、疾病严重程度和PCT检测阈值的不同是产生异质性的原因。结论PCT对新生儿脓毒症诊断效能较高,临床可多应用该诊断指标,有助于脓毒症的早期诊断,同时临床上需要注意联合PCT和其他诊断指标,进一步提高新生儿脓毒症诊断的敏感度和特异度。
Objective To evaluate the value of the procalcitonin（PCT） test for diagnosing neonatal sepsis. Methods A search in Cochrane Library, PubMed, Ovid, Springer, China National Knowledge Infrastructure （CNKI）, Wanfang Chinese Periodical Database and Chinese Bio-medieine Database（ CBM）was performed to identify relevant articles from Januanary 1990 to October 2009. The language of the researches wasn＇t limited. All non-English and non-Chinese articles were translated into Chinese to assess. Inclusion criteria were established based on validity criteria for diagnostic research. Subsequently, the characteristics of the included articles including study background, design information and diagnostic parameters were extracted. Statistical analysis was performed by employing Meta-DiSe 1.4 and SPSS 12.0 software. Heterogeneity of the included articles was tested for selecting proper effect model to calculate pooled weighted sensitivity , specificity and 95% CI. Summary receiver operating characteristic （SROC） curve was made and the area under the curve （AUC） and Q^＊ index was calculated. Finally, sensitivity analysis and comparison of sensitivity among different groups were performed. Results We searched 446 relevant English articles, 98 Chinese articles and 21 other language articles. Thirty-three articles （ 18 English articles, 11 Chinese articles and 4 other language articles） were included, with total 3 599 newborns. Three articles meeting inclusion criteria were analyzed for the value of the PCT test for the diagnosis of clinical early onset neonatal sepsis （EONS） in umbilical cord blood at birth, the pooled sensitivity, specificity and SROC AUC were 77.7% ,82.8% and 0. 833 7 ,respectively. Eight articles meeting inclusion criteria were analyzed for the value of serum PCT levels for the diagnosis of clinical EONS within 0 - 12 h after birth, the pooled sensitivity, specificity and SROC AUC were 76.7% ,87.1% and 0.896 5, respectively. Four articles meeting inclusion criteria were analyzed for the value of serum PCT levels for the diagnosis of clinical EONS within 12 - 24 h after birth, the pooled sensitivity, specificity and SROC AUC were 76.6% ,88.5% and 0.884 4 ,respectively. Six articles meeting inclusion criteria were analyzed for the value of serum PCT levels for diagnosis of clinical EONS within 24 -48 h after birth, the pooled sensitivity, specificity and SROC AUC were 69.8% ,88.2% and 0. 894 7, respectively. Fifteen articles meeting inclusion criteria were analyzed for the value of serum PCT levels for the diagnosis of clinical late onset neonatal sepsis （LONS）, the pooled sensitivity,specificity and SROC AUC were 79.0% ,92.3% and 0. 963 2, respectively. Fifteen articles meeting inclusion criteria were analyzed for the value of serum PCT levels for the diagnosis of proven LONS, the pooled sensitivity, specificity and SROC AUC were 84.5% , 80.9% and 0. 934 5, respectively. Significant heterogeneity among studies was observed. Sensitivity analysis showed that differences in PCT assay producer and PCT cutoff, study countries, gestational age and severity of sepsis in the study population may partially explain the between-studies heterogeneity. Conclusions The PCT test showed good accuracy in diagnosing neonatal sepsis, regardless of differences in diagnostic criteria or time points for testing. PCT should be combined with other diagnostic markers to further improve the sensitivity and accuracy in the diagnosis of sepsis.
出处
《中国循证儿科杂志》
CSCD
2010年第1期25-34,共10页
Chinese Journal of Evidence Based Pediatrics
基金
<中国循证儿科杂志>编辑部上海强生制药儿科系统评价项目资助
