降钙素原对不同热程不明原因发热儿童严重细菌感染诊断价值的Meta分析

目的 探讨降钙素原（PCT）对不同热程不明原因发热儿童严重细菌感染(SBIs)的诊断价值。方法 计算机检索获得PCT对不明原因发热儿童SBIs诊断价值的文献，检索时间为建库至2014年7月，按照QUADAS标准对纳入文献进行质量评估。使用MetaDisc 1.4软件进行Meta分析，对不同平均热程（<24、～48和>48 h）PCT、WBC和中性粒细胞绝对计数（ANC）诊断SBIs的敏感度、特异度等指标进行汇总，并进行异质性检验，绘制综合受试者工作特征曲线（SROC），计算曲线下面积（AUC）。使用Stata 12.0软件判断发表偏倚并绘制漏斗图。结果 初检到442篇文献，11篇文献符合纳入标准进入Meta分析（中文1篇，英文10篇）。①平均热程<24 h对SBIs的诊断价值：PCT的汇总敏感度和特异度分别为0.75（95％CI：0.69~0.80）和0.80（95％CI：0.77~0.83），SROC AUC为0.870（95％CI：0.817~0.923）；WBC的汇总敏感度和特异度分别为0.48（95％CI：0.41~0.55）和0.54（95％CI：0.51~0.58），AUC为0.484（95％CI：0.440~0.663）；ANC的汇总敏感度和特异度分别为0.30（95％CI：0.21~0.40）和0.78（95％CI：0.73~0.83）。②平均热程24~48 h对SBIs的诊断价值：PCT的汇总敏感度和特异度分别为0.86（95％CI：0.79~0.91）和0.63（95％CI：0.60~0.67），AUC为0.857（95％CI：0.761~0.953）；WBC的汇总敏感度和特异度分别为0.54（95％CI：0.44~0.65）和0.46（95％CI：0.41~0.51），AUC为0.558（95％CI：0.479~0.636）；ANC的汇总敏感度和特异度分别为0.47（95％CI：0.28~0.66）和0.12（95％CI：0.08~0.17）。③平均热程>48 h对SBIs的诊断价值：PCT 的汇总敏感度和特异度分别为0.83（95％CI：0.75~0.90）和0.55（95％CI：0.50~0.59），AUC为0.816（95％CI：0.596~0.996）；2篇WBC文献的敏感度分别为0.69（95％CI：0.41~0.89）和0.34（95％CI：0.28~0.41），特异度分别为0.81（95％CI：0.69~0.91）和0.29（95％CI：0.24~0.35）；ANC的敏感度和特异度分别为0.87（95％CI：0.75~0.95）和0.40（95％CI：0.34~0.46）。结论 对不明原因发热儿童诊断SBIs的价值，发热<24 h检测PCT有较高的特异度；发热24~48 h检测PCT有较高的敏感度。

Diagnostic value of procalcitonin for detection of serious bacterial infections in children having different thermal process with fever without source:a meta-analysis

Objective To conduct a systematic review to identify the diagnostic value of procalcitonin（PCT） for detecting serious bacterial infections in children having different thermal process with fever without source (FWS).Methods A comprehensive electronic search was performed to retrieve relevant studies on PCT in diagnosis of serious bacterial infections in children with FWS. From the initiation of the database from establishment to July 2014, QUADAS items were used to evaluate the quality of included studies. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, summary receiver operating characteristic curve (SROC), and the heterogeneity of included studies with different thermal process were analyzed by using Meta-Disk software. Finally, the sensitivity and analysis for heterogeneity cause were performed and Stata 12.0 software was used to assess the publication bias with funnel plot.Results Eleven studies were included for the review, including 10 English studies and 1 Chinese study. The pooled sensitivity and specificity of PCT test for thermal process under 24 h were 0.75(95%CI: 0.69-0.80) and 0.80(95%CI: 0.77-0.83), SROC area under the curve (AUC) was 0.870(95%CI: 0.817-0.923); the pooled sensitivity and specificity of WBC were 0.48(95%CI: 0.41-0.55) and 0.54(95%CI: 0.51-0.58), AUC was 0.484(95%CI: 0.440-0.663); sensitivity and specificity of ANC were 0.30(95%CI: 0.21-0.40) and 0.78(95%CI: 0.73-0.83), respectively. The pooled sensitivity and specificity of PCT test for thermal process between 24 and 48 h were 0.86(95%CI: 0.79-0.91) and 0.63(95%CI: 0.60-0.67), AUC was 0.857(95%CI: 0.761-0.953); the pooled sensitivity and specificity of WBC were 0.54(95%CI: 0.44-0.65) and 0.46(95%CI: 0.41-0.51), AUC 0.558(95%CI: 0.479-0.636); sensitivity and specificity of ANC were 0.47(95%CI: 0.28-0.66) and 0.12(95%CI: 0.08-0.17), respectively. The pooled sensitivity and specificity of PCT test for thermal process over 48 h were 0.83(95%CI: 0.75-0.90) and 0.55(95%CI: 0.50-0.59), AUC was 0.816(95%CI: 0.596-0.996). The sensitivity of WBC in 2 studies were 0.69(95%CI: 0.41-0.89) and 0.34(95%CI: 0.28-0.41), respectively; the specificity of WBC in 2 studies was 0.81(95%CI: 0.69-0.91) and 0.29(95%CI: 0.24-0.35), respectively; sensitivity and specificity of ANC were 0.87(95%CI: 0.75-0.95), 0.40(95%CI: 0.34-0.46).Conclusion When children having different thermal process with FWS, PCT provides a good specificity in the thermal process under 24 h, and provides a good sensitivity in the thermal process between 24 and 48 h. Since the heterogeneity among studies, it should be applied in combination with clinical features and other tests.