C反应蛋白对不明原因发热儿童严重细菌感染诊断价值的系统评价

目的 系统评价CRP对不明原因发热儿童严重细菌感染的诊断价值。方法 检索Medline、EMBASE、Cochrane图书馆、维普中文科技期刊数据库、中国知网、万方数据库和中国生物医学文献数据库，纳入CRP对不明原因发热儿童严重细菌感染诊断价值的文献，检索时间均为建库至2012年10月。采用QUADAS量表对纳入文献进行质量评估，使用MetaDisc 1.4软件对纳入文献进行异质性检验及Meta分析。结果 初检到314篇文献，7篇文献符合纳入标准进入系统评价（n=2 179）。6篇为前瞻性研究，1篇为回顾性研究。CRP的最适界值为30~91 mg·L-1。严重细菌感染的患病率为1.7%~29.3%。4篇文献采用多变量Logistic回归分析显示，CRP是严重细菌感染独立的预测因素。报道敏感度和特异度文献间具有高度的异质性，采用描述性分析，CRP不同最适界值诊断严重细菌感染的敏感度为33%~89%，特异度为75%~97%。报道阳性似然比和阴性似然比的文献间具中度异质性，采用随机效应模式合并，合并阳性似然比为4.43 （95%CI：3.49~5.63），阴性似然比为0.39（95%CI：0.29~0.54）。SROC曲线下面积为0.85，Q指数为0.78。结论 在以不明原因发热就诊的婴幼儿中，CRP对严重细菌感染具有中等的诊断价值，应用时尚需结合临床表现及其他实验室检查指标。

Diagnostic value of C-reactive protein for detection of serious bacterial infections in children with fever without apparent causes: systematic review

Objective To conduct a systematic review to identify the diagnostic value of C-reactive protein for detecting serious bacterial infections in children with fever without apparent causes. Methods Medline, EMBASE, Cochrane Library, VIP Information, China National Knowledge Infrastructure, Wanfang Chinese Periodical Database and Chinese Biomedical Database were searched. QUADAS was used for the quality assessment of included studies, and software MetaDisc 1.4 was used for the test of heterogeneity and meta-analysis. Results Seven studies (n=2 179) were included for the review. Six of them were prospective studies, while one was a retrospective study. None of the studies was assessed with high methodological quality. The prevalence of serious bacterial infections ranged from 1.7% to 29.3%. Multivariate logistic analysis conducted in four studies showed that C-reactive protein was an independent predictor. The sensitivities and specificities of the C-reactive protein with different optimal cut-offs were ranged from 33% to 89%, and 75% to 97% respectively. Random effects meta-analysis yielded a pooled positive likelihood ratio of 4.43 (95%CI:3.49-5.63), and a negative likelihood ratio of 0.39 (95%CI:0.29-0.54). The area under the summary receiver operating characteristic curve was 0.85, and Q index was 0.78. Conclusions C-reactive protein provides a good diagnostic value in infants and young children with fever without apparent causes, it should be applied in combination with clinical features and other tests.