髓样细胞触发受体-1对肺炎诊断价值的Meta分析

[摘要] 目的 研究髓样细胞触发受体-1在肺炎中的诊断价值。 方法 系统检索Medline、Embase、Cochrane Library、中国生物医学文献数据库、中国生物医学期刊文献数据库等数据库，收集利用髓样细胞触发受体-1诊断肺炎的文献。利用QUADAS评分工具评价纳入文献的质量。数据分析采用Meta-Disc 1.4软件检验异质性，并根据异质性结果选择相应的效应模型，计算合并敏感度、特异度、阳性似然比、阴性似然比、诊断优势比及其95% CI。绘制汇总受试者工作特征（SROC）曲线，对诊断性试验的准确性进行综合评估。 结果 共有9篇文献共计889例样本纳入本次meta分析，分析结果显示髓样细胞触发受体-1对肺炎的诊断价值分别为：合并敏感度0.74（95% CI 0.70～0.78），合并特异度0.68（95% CI 0.63～0.72），阳性似然比2.67（95% CI 1.66～4.28），阴性似然比0.34（95% CI 0.20～0.57），诊断优势比 10.76（95% CI 3.89～29.69），SROC曲线下面积为0.84。 结论 髓样细胞触发受体-1在肺炎的诊断中具有一定的临床价值，其检测结果的解读需要综合考虑患者的临床症状和其他检测指标。

[关键词] 髓样细胞触发受体-1；肺炎；Meta分析

[中图分类号] R563.1 [文献标识码] A [文章编号] 1673-7210（2012）08（a）-0071-03

Diagnostic accuracy of triggering receptor expressed on myeloid cells-1 for pneumonia by meta-analysis

YANG Yongzhen WU Ying CAO Yuying

Department of Respiratory Medicine, the First People′s Hospital of Neijiang City, Sichuan Province, Neijiang 641100, China

[Abstract] Objective To assess the value of triggering receptor expressed on myeloid cells-1 (TREM-1) in the diagnosis of pneumonia. Methods A systematic review was conducted in Medline, Embase, Cochrane Library, Chinese Bio-medicine Database, and China Hospital Knowledge Database to identify relevant studies on evaluation of TREM-1 in the diagnosis of pneumonia. The methodological quality of each study was assessed by QUADAS. Statistical analysis was performed by employing Meta-Disc 1.4 software. Heterogeneity of the included articles was evaluated for selecting proper effect model to calculate pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and 95% CI. Summary receiver operating characteristic (SROC) curve was made and the area under the curve (AUC) was calculated. Results Nine studies with 889 samples met the inclusion criteria for present analysis. The summary estimates for TREM-1 in the diagnosis of pneumonia: sensitivity 0.74 (95% CI 0.70, 0.78), specificity 0.68 (95% CI 0.63, 0.72), positive likelihood ratio 2.67 (95% CI 1.66, 4.28), negative likelihood ratio 0.34 (95% CI 0.20, 0.57), diagnostic odds ratio 10.76 (95% CI 3.89,29.69), and the AUC of SROC was 0.84. Conclusion TREM-1 plays a role in the diagnosis of pneumonia, while the results of TREM-1 assays should be interpreted in parallel with clinical symptoms and other test results.

[Key words] Triggering receptor expressed on myeloid cells-1; Pneumonia; Meta-analysis

肺炎是呼吸系统常见的疾病，虽然近年来其治疗取得了较大的进展，但是其门诊死亡率仍在5%左右，住院患者死亡率约12%[1]。早期的识别和诊断肺炎进而早期干预对于降低肺炎患者的死亡率具有重要的临床意义。髓样细胞触发受体-1（triggering receptor expressed on myeloid cells-1，TREM-1）是一个与炎症有关的免疫球蛋白超家族成员，在细菌感染等刺激下，炎性细胞表面的TREM-1表达明显增加，可以提示炎症反应[2]。近年来的研究发现在肺炎等肺部感染性疾病病变时，TREM-1的表达增加，参与肺部炎症的发生与进展[3]，通过检测释放到血液、肺泡灌洗液（bronchoalveolar lavage fluid，BALF）中TREM-1的水平有望为肺炎的诊断和严重程度评估提供新的诊断方法[4]。目前已有不少研究探索了RREM-1对肺炎的诊断价值，但是得出的结论不尽一致，本研究拟从循证医学的角度系统评估TREM-1对肺炎的诊断价值。