降钙素原对儿童细菌性脑膜炎鉴别诊断的Meta分析

目的探讨降钙素原（PCT）对儿童细菌性脑膜炎的诊断价值。方法采用计算机检索获得PCT对儿童细菌性脑膜炎的诊断性研究文献，检索时间为建库至2013年7月，按照QUADAS标准评价纳入文献质量。采用Meta—Disc1．4软件进行Meta分析，对敏感度、特异度、阳性似然比、阴性似然比进行汇总和异质性检验，绘制综合受试者特征曲线（SROC），行敏感性分析和异质性原因分析。使用Stata12．0软件判断发表偏移并绘制漏斗图。结果12篇文献进入Meta分析（中文5篇，英文7篇）。①汇总敏感度0．95（95％CI：0．92—0．97），特异度0．89（95％CI：0．86—0．92），阳性似然比11．09（95％CI：5．73～21．49），阴性似然比0．07（95％CI：0．05～0．11），诊断比值比122．01（95％CI：65．08—228．75），SROC曲线下面积（AUC）0．9777，Q’指数0．933。②分别剔除样本量〈50文献、中文文献和回顾性研究文献的敏感性分析显示，上述诊断参数的95％CI与原数据有较大重叠。③特异度、阳性似然比的文献间存在显著的异质性，研究地域、PCT检测方法和细菌性脑膜炎诊断标准可能不是异质性产生的原因。④以PCT5肛g·L。界值诊断儿童细菌性脑膜炎的敏感度、特异度，SROCAUC和Q’指数最大。结论PCT在鉴别诊断儿童细菌性脑膜炎与病毒性脑膜炎中有较高的敏感度和特异度，但各研究间存在异质性，使用PCT鉴别诊断儿童细菌性脑膜炎仍需结合具体的临床情况。

Meta-analysis of the value of the procalcitonin test for the diagnosis of meningitis in children

Objective To evaluate the value of the proealcitonin （ PCT ） test for diagnosing meningitis in children. Methods A comprehensive electronic search was performed to retrieve relevant studies on PCT in diagnosis of meningitis in children. The time from the initiation of the database to July 2013, QUADAS items was used to evaluate the quality of the included studies. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, summary receiver operating characteristic curve（SROC） ,and the heterogeneity of the included studies were analyzed by using the Meta-Disk software. Finally, the sensitivity analysis and analysis for heterogeneity cause were performed and Stata 12.0 software was used to assess the publication bias with funnel plot. Results A total of 12 literatures were reviewed,including 7 relevant English articles,5 Chinese articles. ①The pooled sensitivity of procalcitonm test for the diagnosis of meningitis in children was 0. 95 （95% CI：0. 92,0. 97 ）, the specificity was 0. 89 （ 95% C1：0. 86,0. 92 ）, the positive likelihood ratio was 11.09 （ 95% CI ： 5.73,21.49 ）, and the negative likelihood ratio was 0. 07 （95% C1：0. 05,0. 11 ）, diagnostic odds ratio was 122.01 （ 95% CI ： 65.08,228.75 ）. SROC area under the curve （ AUC ） was O. 977 7, Q ＊ was 0. 933 0 . ②The sensitivity analysis of removing studies with sample capacity 〈 50 , domestic and retrospective studies showed the confidence interval of the diagnostic parameters had a lot of overlapping with the original data. ③Specificity, positive likelihood ratio had significant heterogeneity. Research areas, PCT test method and diagnostic criteria may not be the cause of heterogeneity of BM. ④The sensitivity , specificity SROC AUC and Q ＊ were the largest when cut-off point of 5 g L - 1was used for the the diagnosis of meningitis in children. Conclusion The use of PCT for the diagnosis of BM in children has a high sensitivity and specificity, but there is heterogeneity between the studies, PCT should be combined with specific clinical situations in the diagnosis of meningitis in children.