中国实用儿科杂志

中国实用儿科杂志 ›› 2024, Vol. 39 ›› Issue (7): 509-517.DOI: 10.19538/j.ek2024070608

• 论著 • 上一篇    下一篇

脑脊液多重聚合酶链反应检测对社区获得性细菌性脑膜炎病原诊断价值Meta分析

  

  1. 1.国家儿童医学中心  首都医科大学附属北京儿童医院  a 感染内科  儿科重大疾病研究教育部重点实验室  中国医学科学院儿童危重感染诊治创新单元，b 临床流行病学与循证医学中心，北京  100045；2.北京市顺义区医院儿科，北京  101300
  • 出版日期:2024-07-06 发布日期:2024-09-09
  • 通讯作者: 刘钢，电子信箱： liugang@bch.com.cn
  • 基金资助:
    国家呼吸系统疾病临床医学研究中心呼吸专项（HXZX-202106）；中国医学科学院医学与健康科技创新工程（2019-I2M-5-026）；北京市自然科学基金-海淀原始创新联合基金项目（L202004）；北京市医院管理中心“青苗”计划专项（QML20191203）；北京市优秀人才培养资助青年骨干个人项目（2018000021469G274）；北京市属医院科研培育计划（PX2024042）

Value of multiple polymerase chain reaction test in cerebrospinal fluid for pathogenic diagnosis of community-acquired bacterial meningitis：a meta-analysis

  1. Department of Infectious Diseases，Key Laboratory of Major Diseases in Children，Ministry of Education，Beijing Children's Hospital，Capital Medical University，National Center for Children's Health，Beijing   100045，China
  • Online:2024-07-06 Published:2024-09-09

摘要： 目的    系统评价脑脊液多重聚合酶链反应（mPCR）检测对社区获得性细菌性脑膜炎（CABM）病原诊断的诊断价值。方法    2021年9月首都医科大学附属北京儿童医院感染内科按检索策略通过计算机检索万方、Sinomed、Pubmed、Cochrane Library、Embase数据库，获得mPCR对CABM的诊断价值的相关文献，检索时间为建库至2021年9月。由2名研究者独立进行文献筛选、质量评价和数据提取。采用Stata11.0软件进行Meta分析，计算合并灵敏度、特异度、阳性似然比、阴性似然比和诊断优势比，绘制综合受试者工作特征（SROC）曲线，并计算曲线下面积（AUC）。根据研究类型、病原菌种类及患者群进行亚组分析，通过逐一剔除法进行敏感性分析，采用 Deek’s漏斗图法进行发表偏倚的评估。结果    共检索出279篇文献，最终纳入19篇文献共计4679例患者。Meta分析结果显示，脑脊液mPCR检测可提升0.89%～49.51%的细菌培养病原阳性率，合并灵敏度和特异度分别为0.91（95% CI 0.75～0.97）和0.88（95% CI 0.78～0.94），阳性似然比和阴性似然比为7.7（95% CI 3.9～15.2）和0.11（95% CI 0.04～0.31），诊断优势比为72（95% CI 18～295），AUC为0.95（95% CI 0.93～0.97）。亚组分析结果显示脑脊液mPCR检测对CABM三种常见病原体（肺炎链球菌、脑膜炎奈瑟菌和流感嗜血杆菌）及儿童人群均具有较高的诊断效能。敏感性分析表明本研究结果稳定可信。结论    脑脊液mPCR检测对CABM病原诊断具有较高的诊断效能，可作为CABM病原诊断的辅助方法。

关键词: 社区获得性细菌性脑膜炎, 多重聚合酶链反应, 诊断价值, Meta分析

Abstract: Objective    To systematically evaluate the value of multiple polymerase chain reaction（mPCR）in cerebrospinal fluid for pathogenic diagnosis of community-acquired bacterial meningitis（CABM）. Methods    Wanfang，Sinomed，Pubmed，Cochrane Library and Embase databases were searched from the establishment of the database to September 2021 according to the retrieval strategy. Two researchers conducted literature screening，quality assessment and data extraction independently. Meta-analysis was performed using Stata11.0 to calculate the combined sensitivity，specificity，positive likelihood ratio，negative likelihood ratio and diagnostic odds ratio. The subject receiver operating characteristic（SROC）curve was drawn and the area under the curve（AUC）was also calculated.Subgroup analysis was performed according to study type，pathogen species and affected population. Sensitivity analysis was performed by one-by-one exclusion method，and publication bias was evaluated by Deek's funnel plot method.Results    A total of 279 articles were retrieved，and 4679 cases of 19 articles were finally included according to exclusion and inclusion criteria. Meta-analysis showed that mPCR in CSF could increase the positive rate of bacterial culture pathogens by 0.89%～49.51%. The combined sensitivity and specificity of mPCR in CSF were 0.91［95% CI 0.75-0.97］ and 0.88［95%CI 0.78-0.94］，and the positive and negative likelihood ratios were 7.7［95% CI 3.9-15.2］ and 0.11［95% CI 0.04-0.31］，respectively. The diagnostic odds ratio was 72 ［95% CI 18-295］and the AUC was 0.95［95% CI 0.93-0.97］. Subgroup analysis showed that mPCR detection had high diagnostic efficiency for three common pathogens of CABM（Streptococcus pneumoniae，Haemophilus and Meningococcal）and children. Sensitivity analysis showed that the results of this study were stable and credible. Conclusion    The mPCR test in cerebrospinal fluid has high diagnostic efficiency in the diagnosis of CABM，and can be used as an auxiliary method for the pathogenic diagnosis of CABM.

Key words: community acquired bacterial meningitis, CABM, multiplex polymerase chain reaction, mPCR, diagnostic value, meta-analysis