中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2015年
9期
743-749
,共7页
尹承芬%李彤%高心晶%李智伯%徐磊
尹承芬%李彤%高心晶%李智伯%徐磊
윤승분%리동%고심정%리지백%서뢰
脓毒症%降钙素原%Meta分析
膿毒癥%降鈣素原%Meta分析
농독증%강개소원%Meta분석
Sepsis%Procalcitonin%Meta-analysis
目的：系统评价血浆降钙素原（PCT）诊断成人脓毒症的准确性。方法检索万方数据库、中国知网、维普数据库、美国国立医学图书馆MEDLINE数据库、荷兰医学文摘EMBASE数据库、Cochrane临床试验数据库自建库至2014年12月发表的文献。纳入有关PCT诊断脓毒症的前瞻性观察性研究或随机对照试验；研究对象年龄≥18岁；试验组为脓毒症、严重脓毒症或脓毒性休克患者，对照组为非感染因素引起的全身炎症反应综合征（SIRS）患者；语种为英文或中文。采用QUADAS-2工具对文献进行质量评价，利用Metadisc 1.4软件进行异质性分析，并计算合并后的诊断优势比（DOR）、合并敏感度、合并特异度、合并阳性似然比和合并阴性似然比，进行合并受试者工作特征曲线（SROC）分析，获得合并SROC曲线下面积（AUC），并进行亚组分析。结果共检索到6385篇文献，最终纳入24篇、共3107例患者。纳入各研究间存在异质性（I2＝69.4%），采用随机效应模型进行Meta分析，结果显示，合并DOR为10.37〔95%可信区间（95%CI）＝7.10～15.17〕。阈值效应分析显示，敏感度对数和1－特异度对数的Spearman相关系数＝0.27，P＝0.20，提示不存在阈值效应。森林图中，各研究的DOR与合并DOR不沿同一直线分布，同时Cochran-Q＝78.33，P＝0.0000，表明存在非阈值效应引起的异质性。去除非阈值效应引起的部分异质性，并对PCT检测方法、疾病类型、研究地点等因素进行Meta回归分析显示，P值均＞0.05，说明各研究间仍存在部分不能解释的异质性。合并效应量结果显示，合并敏感度为74%（95%CI＝72%～76%），合并特异度为70%（95%CI＝67%～72%），合并阳性似然比为2.79（95%CI＝2.31～3.38），合并阴性似然比为0.34（95%CI＝0.28～0.41），合并AUC为0.83（95%CI＝0.79～0.87）。亚组分析结果显示，内科组合并AUC为0.80（95%CI＝0.75～0.85），高于外科组合并AUC〔0.71（95%CI＝0.65～0.81）〕。结论 PCT对成人脓毒症具有中等诊断价值，且对内科患者脓毒症诊断的准确性高于外科患者，是较好的脓毒症辅助诊断指标。
目的：繫統評價血漿降鈣素原（PCT）診斷成人膿毒癥的準確性。方法檢索萬方數據庫、中國知網、維普數據庫、美國國立醫學圖書館MEDLINE數據庫、荷蘭醫學文摘EMBASE數據庫、Cochrane臨床試驗數據庫自建庫至2014年12月髮錶的文獻。納入有關PCT診斷膿毒癥的前瞻性觀察性研究或隨機對照試驗；研究對象年齡≥18歲；試驗組為膿毒癥、嚴重膿毒癥或膿毒性休剋患者，對照組為非感染因素引起的全身炎癥反應綜閤徵（SIRS）患者；語種為英文或中文。採用QUADAS-2工具對文獻進行質量評價，利用Metadisc 1.4軟件進行異質性分析，併計算閤併後的診斷優勢比（DOR）、閤併敏感度、閤併特異度、閤併暘性似然比和閤併陰性似然比，進行閤併受試者工作特徵麯線（SROC）分析，穫得閤併SROC麯線下麵積（AUC），併進行亞組分析。結果共檢索到6385篇文獻，最終納入24篇、共3107例患者。納入各研究間存在異質性（I2＝69.4%），採用隨機效應模型進行Meta分析，結果顯示，閤併DOR為10.37〔95%可信區間（95%CI）＝7.10～15.17〕。閾值效應分析顯示，敏感度對數和1－特異度對數的Spearman相關繫數＝0.27，P＝0.20，提示不存在閾值效應。森林圖中，各研究的DOR與閤併DOR不沿同一直線分佈，同時Cochran-Q＝78.33，P＝0.0000，錶明存在非閾值效應引起的異質性。去除非閾值效應引起的部分異質性，併對PCT檢測方法、疾病類型、研究地點等因素進行Meta迴歸分析顯示，P值均＞0.05，說明各研究間仍存在部分不能解釋的異質性。閤併效應量結果顯示，閤併敏感度為74%（95%CI＝72%～76%），閤併特異度為70%（95%CI＝67%～72%），閤併暘性似然比為2.79（95%CI＝2.31～3.38），閤併陰性似然比為0.34（95%CI＝0.28～0.41），閤併AUC為0.83（95%CI＝0.79～0.87）。亞組分析結果顯示，內科組閤併AUC為0.80（95%CI＝0.75～0.85），高于外科組閤併AUC〔0.71（95%CI＝0.65～0.81）〕。結論 PCT對成人膿毒癥具有中等診斷價值，且對內科患者膿毒癥診斷的準確性高于外科患者，是較好的膿毒癥輔助診斷指標。
목적：계통평개혈장강개소원（PCT）진단성인농독증적준학성。방법검색만방수거고、중국지망、유보수거고、미국국립의학도서관MEDLINE수거고、하란의학문적EMBASE수거고、Cochrane림상시험수거고자건고지2014년12월발표적문헌。납입유관PCT진단농독증적전첨성관찰성연구혹수궤대조시험；연구대상년령≥18세；시험조위농독증、엄중농독증혹농독성휴극환자，대조조위비감염인소인기적전신염증반응종합정（SIRS）환자；어충위영문혹중문。채용QUADAS-2공구대문헌진행질량평개，이용Metadisc 1.4연건진행이질성분석，병계산합병후적진단우세비（DOR）、합병민감도、합병특이도、합병양성사연비화합병음성사연비，진행합병수시자공작특정곡선（SROC）분석，획득합병SROC곡선하면적（AUC），병진행아조분석。결과공검색도6385편문헌，최종납입24편、공3107례환자。납입각연구간존재이질성（I2＝69.4%），채용수궤효응모형진행Meta분석，결과현시，합병DOR위10.37〔95%가신구간（95%CI）＝7.10～15.17〕。역치효응분석현시，민감도대수화1－특이도대수적Spearman상관계수＝0.27，P＝0.20，제시불존재역치효응。삼림도중，각연구적DOR여합병DOR불연동일직선분포，동시Cochran-Q＝78.33，P＝0.0000，표명존재비역치효응인기적이질성。거제비역치효응인기적부분이질성，병대PCT검측방법、질병류형、연구지점등인소진행Meta회귀분석현시，P치균＞0.05，설명각연구간잉존재부분불능해석적이질성。합병효응량결과현시，합병민감도위74%（95%CI＝72%～76%），합병특이도위70%（95%CI＝67%～72%），합병양성사연비위2.79（95%CI＝2.31～3.38），합병음성사연비위0.34（95%CI＝0.28～0.41），합병AUC위0.83（95%CI＝0.79～0.87）。아조분석결과현시，내과조합병AUC위0.80（95%CI＝0.75～0.85），고우외과조합병AUC〔0.71（95%CI＝0.65～0.81）〕。결론 PCT대성인농독증구유중등진단개치，차대내과환자농독증진단적준학성고우외과환자，시교호적농독증보조진단지표。
ObjectiveTo assess the clinical value of procalcitonin (PCT) in the diagnosis of sepsis in adults.Methods An extensive search for related literature from the Wanfang data, CNKI, VIP, Medline/PubMed, Embase/OvidSP and the Cochrane Library up to December 2014 was performed. The articles, including prospective observational studies or randomized controlled trials, regarding PCT for the diagnosing of sepsis were enrolled. Only patients older than 18 years were included. Patients with sepsis, severe sepsis, or septic shock served as the experimental group, and those with a systemic inflammatory response syndrome (SIRS) of non-infectious origin as control group. The language of literature included was English or Chinese. The quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Heterogeneity, pooled diagnostic odds ratio (DOR), pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, the area under the summary receiver operating characteristic curve (SROC) and subgroup analysis were analyzed with the software of Metadisc 1.4.Results A total of 6 385 published reports were collected, and among them 24 met the inclusion criteria, including a total of 3 107 patients. The studies showed substantial heterogeneity (I2 = 69.4%), and random effect model was used for Meta analysis, showing that the pooledDOR was 10.37 [95% confidence interval (95%CI) = 7.10-15.17]. No evidence of a threshold effect was found (Spearman correlation coefficient = 0.27, calculated by logarithm of sensitivity and logarithm of 1-specificity,P = 0.20). TheDOR values of pooled and each study were not distributed along the same line in forest plots, and Cochran-Q = 78.33,P = 0.000 0, showing that there was heterogeneity in result from non threshold effect. Except for partial heterogeneity caused by non threshold effect, the result of Meta regression analysis including PCT detection method, categories of disease, research location and so on showedP values were all higher than 0.05. Thus, the heterogeneity could not be explained by Meta regression analysis. The pooled sensitivity was 74% (95%CI = 72%-76%), the pooled specificity was 70% (95%CI = 67%-72%), the pooled positive likelihood ratio was 2.79 (95%CI = 2.31-3.38), the pooled negative likelihood ratio was 0.34 (95%CI = 0.28-0.41), and the pooled AUC was 0.83 (95%CI = 0.79-0.87). AUC in medical patients was 0.80 (95%CI = 0.75-0.85), which was higher than that in surgical patients [0.71 (95%CI = 0.65-0.81)].Conclusions Our results indicate a moderate degree of value of PCT for diagnosis of sepsis in adult patients. The diagnostic accuracy in medical patients is higher than that in surgical patients. PCT is a good auxiliary biomarker for diagnosis of sepsis.
