【摘要】 目的评价降钙素原(PCT)和血浆可溶性髓样细胞触发受体1(s TREM-1)对呼吸机相关性肺炎(VAP)的诊断价值。方法系统检索Pub Med、Ovid SP(EMBASE)、Cochrane Library、clinicaltrials.gov、EBSCO、CBM、CNKI和中国万方数据库,检索截止时间为2013年12月。使用QUADAS量表对纳入文献的质量进行评价。通过Meta-disc软件对PCT和s TREM-1诊断VAP的敏感性、特异性、阳性似然比、阴性似然比、诊断比值比分别进行合并,并计算sROC曲线下面积(AUC),两者AUC的比较使用Z检验,并根据贝叶斯理论计算相应的验后概率。结果最终31篇文献纳入研究,其中PCT文献20篇,s TREM-1文献11篇。合并后结果提示,PCT诊断VAP的敏感性和特异性分别为0.78和0.74,诊断比值比为15.21,AUC为0.868。s TREM-1诊断VAP敏感性和特异性为0.88和0.80,诊断比值比为30.28,AUC为0.919。两者AUC比较差异无统计学意义(P=0.25)。结论结合贝叶斯理论,s TREM-1与PCT相比对VAP的诊断有较高的价值,但是两者均无法作为单独的手段用于诊断或排除VAP。更多还原

【Abstract】 Objective To compare and evaluate the diagnostic value of procalcitonin( PCT) and soluble triggering receptor expressed on myeloid cells-1( s TREM-1) for ventilator-associated pneumonia( VAP). Methods The related studies were systematically searched in Pub Med,Ovid SP( EMBASE),Cochrane Library,clinicaltrials. gov,EBSCO,CBM,CNKI and Wanfang database and the methodological quality of all eligible studies were assessed using the Quality Assessment for Studies of Diagnostic Accuracy( QUADAS) tool. The sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio( DOR),and areas under the summary receiver operating characteristic( sROC) curve of PCT and s TREM-1 were pooled by Meta-disc software,respectively. Area under the sROC curve( AUC) was compared using Z-test. In addition,Bayes ’s theorem was used to calculate the probability of VAP,conditioned by the likelihood ratio as a function of the pretest probability. Results In total,31 studies were included( 20 studies on PCT and 11 studies on s TREM-1). The combined sensitivity,specificity,DOR and AUC of diagnosing VAP by PCT was 0. 78,0. 74,15. 21,and 0. 868,respectively. And the combined sensitivity,specificity,DOR and AUC of diagnosing VAP by s TREM-1 was 0. 88,0. 80,30. 28,and 0. 919,respectively. There was no statistical difference between two areas under the sROC curve( P = 0. 25).Conclusion s TREM-1 is superior to PCT in diagnosing VAP,however,neither can confirm nor exclude VAP alone.更多还原