脑脊液肿瘤坏死因子α检测对细菌性脑膜炎与病毒性脑膜炎鉴别诊断价值的Meta分析  

Diagnostic Accuracy of Cerebrospinal Fluid Tumor Necrosis Factor - α for Differentiating Bacterial Meningitis from Viral Meningitis: A Meta - analysis

作　　者：邓敏峰[1] 龙曼[2] 柯以铨[1] 

机构地区：[1]南方医科大学珠江医院神经外科,广东省广州市510280 [2]南方医科大学珠江医院超声诊断科,广东省广州市510280

出　　处：《中国全科医学》2013年第23期2718-2723,共6页Chinese General Practice

摘　　要：目的评价脑脊液肿瘤坏死因子α(TNF-α)检测对细菌性脑膜炎与病毒性脑膜炎的鉴别诊断价值。方法计算机检索国内外有关脑脊液TNF-α检测鉴别诊断细菌性脑膜炎与病毒性脑膜炎的文献,采用诊断类文献系统质量评价条目(QUADAS)评价文献质量,Meta-Disc 1.4软件进行Meta分析;绘制综合受试者工作特征(SROC)曲线评估诊断性试验的准确性,并根据国家、研究人群、TNF-α检测方法进行亚组分析。结果共纳入符合标准的文献21篇,其中20篇文献质量评价结果较好,1篇文献质量评价结果较差。Meta分析结果显示,脑脊液TNF-α检测鉴别诊断细菌性脑膜炎与病毒性脑膜炎的合并敏感度为0.80,95%CI为(0.76,0.83);合并特异度为0.92,95%CI为(0.89,0.94);合并阳性似然比为7.55,95%CI为(5.26,10.83);合并阴性似然比为0.26,95%CI为(0.21,0.32);合并诊断比值比为38.52,95%CI为(23.08,64.29)。SROC的曲线下面积(AUC)为0.9174(SE=0.0182),Q*为0.8504(SE=0.0207)。亚组分析结果显示,各亚组脑脊液TNF-α检测鉴别诊断细菌性脑膜炎与病毒性脑膜炎的AUC比较,差异均无统计学意义(P>0.05)。结论现有的文献证据表明,脑脊液TNF-α检测对于鉴别诊断细菌性脑膜炎与病毒性脑膜炎具有较高的敏感度和特异度,诊断效能较高。Objective To evaluate the overall diagnostic accuracy of cerebrospinal fluid tumor necrosis factor - α （TNF-α） for differentiating bacterial meningitis from viral meningitis. Methods We conducted a comprehensive search for studies on use of cerebrospinal fluid TNF - α for differentiating bacterial meningitis from viral meningitis in domestic and interna- tional literature. The methodological quality of the included studies were assessed using Quality Assessment of Diagnostic Accura- cy Studies （QUADAS）. Meta- Disc 1.4 was used for Meta -analysis. Summary Receiver Operating Characteristic （SROC） curve was drawn to evaluate the accuracy of the diagnostic test. Subgroup analyses of included studies were conducted based on country, patients group and TNF -α detection method. Results Twenty - one studies met the inclusion criteria for the analysis, among which, 20 had good assessment results, and 1 had bad assessment result. The use of TNF -α in differentiating bacterial meningitis from viral meningitis had a sensitivity of 0. 80 [95% CI （0. 76, 0. 83） 3 , a specificity of 0. 92 [95% CI （0. 89, 0. 94） ], a positive likelihood ratio of 7.55 [ 95 % CI （5.26, 10. 83 ） 3, a negative likelihood ratio of 0. 26 -95 % CI （0. 21, 0.32）3, anda diagnostic odds ratio of 38. 52 [95%CI （23.08, 64. 29）1. Area under the curve （AUC） of SROC was 0. 9174 （SE=0. 0182） , and Q was 0. 8504 （SE = 0. 0207 ）. No significant differences of AUC were found among all sub- groups （P 〉 0. 05 ）. Conclusion Cerebrospinal fluid TNF -α has a high sensitivity and specificity to differentiate bacterial meningitis from viral meningitis. It might be a valuable marker for future use.

关 键 词：脑脊液 肿瘤坏死因子Α 脑膜炎 细菌性脑膜炎 病毒性 META分析 

分 类 号：R742[医药卫生—神经病学与精神病学]