摘要
目的荟萃分析血清可溶性白细胞分化抗原14亚型(sCD14-ST,presepsin)检测对新生儿败血症(NS)的诊断价值。方法采用Cochrane系统评价方法,应用计算机检索PubMed、Web of Science等英文数据库,以及中国知网、万方数据知识服务平台等中文数据库中,有关血清presepsin检测对NS诊断价值的前瞻性或回顾性病例对照研究文献。检索时间设定为1990年1月至2020年9月。按照本研究设定的检索策略进行文献检索、筛选、提取,采用诊断准确性研究质量评价工具(QUADAS-2)进行文献质量评价,采用Meta-Disc 1.4及Stata 14.0软件进行Meta分析。血清presepsin检测诊断NS的主要结局指标为合并敏感度、特异度、阳性似然比(PLR)、阴性似然比(NLR)、诊断比值比(DOR),汇总受试者工作特征(SROC)曲线及其曲线下面积(AUC)。采用血清presepsin检测诊断NS的SROC曲线分布特征及其敏感度对数与(1-特异度)对数的Spearman相关系数,评价阈值效应;采用Cochrane-Q检验分析纳入研究文献的异质性,并采用亚组分析进一步探讨该异质性来源。绘制Deek′s漏斗图,分析文献发表偏倚。结果对最终纳入的15篇文献中血清presepsin检测诊断NS价值研究结果如下。①共计纳入6个国家的1394例新生儿,研究组为NS患儿(n=812),对照组为非NS患儿(n=582)。②本研究纳入文献偏倚风险均在可接受范围,NS诊断标准适用性高,符合QUADAS-2质量评价标准。③绘制纳入15篇文献中,血清presepsin检测诊断NS的SROC曲线结果显示,SROC曲线未呈典型“肩臂状”分布,诊断NS敏感度对数与(1-特异度)对数的Spearman相关系数为-0.020(P=0.945),表明研究间不存在阈值效应。血清presepsin检测诊断NS敏感度、特异度、PLR、NLR、DOR,均存在高度异质性(I^(2)=81.0%、75.8%、67.2%、76.3%、68.7%,P均<0.001),提示纳入研究文献间存在非阈值效应引起的异质性,故采用随机效应模型进行Meta分析。血清presepsin检�
Objective To explore diagnostic values of serum soluble CD14 subtype(sCD14-ST,presepsin)in neonatal sepsis(NS)by Meta-analysis.Methods Prospective or retrospective case-control studies literature on diagnostic value of serum presepsin in NS in English databases such as PubMed and Web of Science,as well as Chinese databases such as CNKI and Wanfang database were searched by computer and Cochrane system evaluation method.Literature retrieval time was set from January 1990 to September 2020.According to retrieval strategies set in this study,researchers searched and screened literature and extracted data,and evaluated quality of literature by Quality Assessment of Diagnostic Accuracy Studies 2(QUADAS-2),and then used Meta-Disc 1.4 and Stata 14.0 software for Meta-analysis.The main outcome indicators of serum presepsin in diagnosis of NS were combined sensitivity,specificity,positive likelihood ratio(PLR),negative likelihood ratio(NLR),and diagnostic odds ratio(DOR),summary receiver operating characteristics(SROC)curve and area under curve(AUC).Threshold effect was evaluated by distribution characteristics of SROC curve and Spearman correlation coefficient between sensitivity logarithm and(1-specificity)logarithm of serum presepsin in diagnosis of NS.Heterogeneity between studies was analyzed by Cochrane-Q test,and the source of heterogeneity was further explored by subgroup analysis.Publication bias was analyzed by Deek′s funnel plot.Results A total of 15 pieces of literature were finally included,and results of study on value of serum presepsin in diagnosis of NS were as follows.①A total of 1394 newborns from 6 countries were included with 812 cases of NS children in study group and 582 cases of non-NS children in control group.②The 15 pieces of literature met the criteria of diagnostic accuracy quality evaluation of QUADAS-2 with acceptable bias risk and applicable NS diagnostic standard.③Results of SROC curve of serum presepsin in diagnosis of NS in 15 pieces of included literature showed that SROC curve
作者
林巧
王华
Lin Qiao;Wang Hua(Department of Neonatology,Key Laboratory of Birth Defects and Related Diseases of Women and Children(Sichuan University),Ministry of Education,West China Second University Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China)
出处
《中华妇幼临床医学杂志（电子版）》
CAS
2021年第6期699-708,共10页
Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)
基金
四川省科技厅应用基础研究项目(2021YJ0171)。
