脑脊液乳酸对神经外科术后细菌性脑膜炎诊断价值的Meta分析  

Diagnostic value of cerebrospinal fluid lactate for bacterial meningitis after neurosurgical procedure： a meta-analysis

作　　者：肖雄[1] 张扬[1] 张力伟[1] 季楠[1] 

机构地区：[1]国家神经系统疾病临床医学研究中心,首都医科大学附属北京天坛医院神经外科,100050

出　　处：《中华神经外科杂志》2016年第2期172-176,共5页Chinese Journal of Neurosurgery

基　　金：国家科技支撑计划（2013BA109B03）

摘　　要：目的 系统评价脑脊液乳酸对神经外科术后细菌性脑膜炎的诊断价值.方法 检索PubMed、EBSCO、Cochrane Library、Clinical Trials数据库中有关脑脊液乳酸浓度对神经外科术后细菌性脑膜炎诊断价值的文献,检索时间均从数据库建立至2014年12月.采用诊断性试验准确性质量评价工具（QUADAS）评价纳入文献的质量,应用Meta-DiSc 1.4及Review Manager 5.3等软件对纳入的文献进行分析,并绘制森林图和受试者工作特征曲线（ROC）曲线.结果 共检索文献1 471篇,根据纳入标准筛选出5篇（404例）文献.其中前瞻性研究4项,回顾性研究1项.随机效应模型合并统计显示,脑脊液乳酸对神经外科术后细菌性脑膜炎诊断的敏感度为0.92（95％CI：0.85 ～ 0.96,I2 =0.0％,P=0.6699）,特异性为0.88（95％ CI：0.84～0.92,,=79.5％,P=0.0006）,阳性似然比为7.70（95％ CI：3.94 ～ 15.05,I2=59.5％,P=0.0428）,阴性似然比为0.11（95％ CI：0.06 ～0.19,I2 =0％,P=0.8504）,诊断优势比为83.09（95％ CI：36.83 ～ 187.46,I2=1.8％,P=0.3960）,ROC曲线下面积（AUC）=0.9601（Q＊=0.9046）.结论 Meta分析显示,脑脊液乳酸浓度对神经外科术后细菌性脑膜炎的诊断具有较高的敏感度和特异性,具有较好的诊断效能.Objective To systematically evaluate the diagnostic value of cerebrospinal fluid （CSF） lactate for bacterial meningitis after neurosurgical procedure.Methods The literature about the diagnostic value of cerebrospinal fluid lactate concentration for bacterial meningitis after neurosurgical procedure were retrieved from PubMed,EBSCO,Cochrane Library,and ClinicalTrials database.The retrieval time was from the establishment of the databases to December 2014.A tool for the quality assessment of studies of diagnostic accuracy （QUADAS） was used to evaluate the quality of the included literature.The Meta-DiSc 1.4 and Review Manager 5.3 softwares were used to analyze the included literature;and the Forest plots and receiver operating characteristic curve （ROC） were drawn.Results A total of 1 471 articles were retrieved.Five articles with 404 patients were screened out according to the inclusion criteria,in which,there were 4 prospective studies and 1 retrospective study.The Random effect model and statistics showed that the sensitivity of CSF lactate for the diagnosis of bacterial meningitis after neurosurgical procedure was 0.92 （95% CI 0.85-0.96,I2 =0.0%;P =0.6699）,the specificity was 0.88 （95% CI 0.84-0.92,I2 =79.5%;P =0.0006）,the positive likelihood ratio was 7.70 （95% CI 3.94-15.05,I2 =59.5%,P =0.0428）,the negative likelihood ratio was 0.11 （95% CI 0.06-0.19,I2 =0%;P =0.8504）,the diagnostic odds ratio was 83.09 （95% CI 36.83-187.46,I2 =1.8%;P =0.3960）,and the area under the ROC curve （AUC） was 0.9601 （Q＊ =0.9046）.Conclusions Meta-analysis has showed that the cerebrospinal fluid lactate concentration has higher sensitivity and specificity for the diagnosis of bacterial meningitis after neurosurgical procedure.It has better efficacy.

关 键 词：中枢神经系统细菌感染 乳酸 脑脊髓液 神经外科手术 META分析 

分 类 号：R651[医药卫生—外科学] R515.3[医药卫生—临床医学]