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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Meta Disc 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。
Objective To investigate the value of procalcitonin (PCT) in the diagnosis of severe bacterial infections (SBIs) in children with pyrogen fever of unknown fever. Methods The computer-based literature search of the PCT for the diagnostic value of SBIs in children with unexplained fever was performed. The search time was from July to July 2014, and the quality of the included articles was assessed according to the QUADAS standard. Meta-analysis was performed using Meta Disc 1.4 software, and the sensitivity, specificity, etc. of SBIs diagnosed by PCT, WBC and neutrophil absolute counts (<24, ~ 48 and> 48 h) , And heterogeneity test, draw a comprehensive receiver operating characteristic curve (SROC), calculate the area under the curve (AUC). Use Stata 12.0 software to determine publication bias and plot the funnel. Results The initial examination of 442 articles, 11 articles met the inclusion criteria into the Meta analysis (1 Chinese, 10 English). 1 The diagnostic value of SBIs for <24 h on average: The combined sensitivity and specificity of PCT were 0.75 (95% CI: 0.69-0.80) and 0.80 (95% CI: 0.77-0.83), respectively. The SROC AUC was 0.870 (95% CI: 0.51-0.58) and AUC 0.484 (95% CI: 0.440, 95% CI: 0.817-0.923). The overall sensitivity and specificity of WBC were 0.48 ~ 0.663). The summary sensitivity and specificity of ANC were 0.30 (95% CI: 0.21-0.40) and 0.78 (95% CI: 0.73-0.83), respectively. (2) The diagnostic value of SBIs from 24 to 48 h on the average heat stroke: The summary sensitivity and specificity of PCT were 0.86 (95% CI: 0.79-0.91) and 0.63 (95% CI: 0.60-0.67) (95% CI: 0.41-0.51) and AUC of 0.558 (95% CI: 0.479; 95% CI: 0.761-0.953). The overall sensitivity and specificity of WBC were 0.54 ~ 0.636). The summary sensitivity and specificity of ANC were 0.47 (95% CI: 0.28-0.66) and 0.12 (95% CI: 0.08-0.17), respectively. 3 The average diagnostic value of SBIs> 48 h: The combined sensitivity and specificity of PCT were 0.83 (95% CI: 0.75-0.90) and 0.55 (95% CI: 0.50-0.59) % CI: 0.596 ~ 0.996). The sensitivities of two WBC documents were 0.69 (95% CI: 0.41-0.89) and 0.34 (95% CI: 0.28-0.41) ~ 0.91) and 0.29 (95% CI: 0.24 ~ 0.35). The ANC sensitivity and specificity were 0.87 (95% CI: 0.75-0.95) and 0.40 (95% CI: 0.34-0.46), respectively. Conclusion The diagnostic value of SBIs in children with unexplained fever is higher than that in the detection of PCT for 24 hours and the sensitivity of PCT in 24-48 hours of fever is higher.