C反应蛋白对儿童细菌性肺炎鉴别诊断价值的meta分析

目的应用meta分析方法对C反应蛋白(CRP)在儿童细菌性和非细菌性肺炎鉴别诊断中的价值进行评价。方法按照系统评价的要求,全面检索1980年至2010年PubMed、Medline、EMBASE以及中国生物医学文献数据库中所有有关研究CRP鉴别诊断儿童细菌性和非细菌性肺炎的文献,并进行meta分析。结果符合纳入标准的文献有7篇,共计1 165例患儿。如果以40～60 mg/L作为CRP诊断阈值进行合并,合并后的总灵敏度为47%(42%～51%),总特异度为65%(61%～68%);总阳性似然率为1.50(1.20～1.88),总阴性似然率为0.75(0.60～0.92)。合并后的受试者工作特征曲线(SROC)的曲线下面积(AUC)为0.64。结论 CRP在儿童细菌性和非细菌性肺炎鉴别诊断中有一定价值,但需要更多高质量、大样本、多中心的研究加以验证。

Diagnostic value of C-reactive protein in bacterial pneumonia in children:a systematic review with meta-analysis

Objective To systematically evaluate the efficacy of C-reactive protein(CRP)in differentiating bacterial from nonbacterial community-acquired pneumonia in children.Methods According to the requirements of Cochrane systematic review,a thorough literature search relevant to CRP and pneumonia was performed among PubMed,Medline,EMBASE and China Biology Medicine disc et al from 1990 to 2010 in any language.Results Seven placebo-controlled literatures and 1 165 children were included.The primary outcome measure was the odds ratio of patients with bacterial or mixed etiology pneumonia and serum CRP concentrations exceeding 30-60 mg/L.The value of the weighted sensitivity was 47%(42%-51%),the specificity was 65%(61%-68%),the positive likelihood ratio was 1.50(1.20-1.88),the negative likelihood ratio was 0.75(0.60-0.92),and the summary receiver operating characteristic(SROC)area under the curve(AUC)was 0.64.Conclusions C-reactive protein can be regarded as a valuable marker in differentiating bacterial from nonbacterial pneumonia.However,more high-quality,large-sized and multi-center studies are still required to evaluate its clinical value.