Ⅰ类整合子对铜绿假单胞菌亚胺培南耐药诊断价值的Meta分析  

Class Ⅰ integron for diagnosing imipenem resistance of Pseudomonas aeruginosa:a Meta-analysis

作　　者：黄秋兰 范德平 高守霞 刘红绸 薛娜丽 倪语星[2] 

机构地区：[1]上海南翔医院医学检验科,上海201802 [2]上海交通大学医学院附属瑞金医院微生物科,上海200025

出　　处：《检验医学》2016年第6期491-498,共8页Laboratory Medicine

基　　金：上海市嘉定区科学技术委员会基金资助项目(2014-KW-15)

摘　　要：目的 通过Meta分析探讨Ⅰ类整合子与铜绿假单胞菌亚胺培南耐药的相关性,以及Ⅰ类整合子检测在诊断铜绿假单胞菌亚胺培南耐药中的临床价值.方法 通过计算机检索中国生物医学文献数据库（CBM）、中国知网（CNKI）、万方数据库、维普数据库（VIP）以及英文PubMed、Embase数据库,检索国内外关于Ⅰ类整合子与铜绿假单胞菌亚胺培南耐药相关性的文献,检索时间均为建库至2015年12月,按纳入、排除标准由2位人员独立进行文献筛选、资料提取和质量评价,采用RevMan 5.2和Meta-Disc 1.4软件进行Meta分析.结果 符合纳入标准的文献共24篇,包含2 101株临床分离的铜绿假单胞菌,其中Ⅰ类整合子阳性1 134株（54.0%）,亚胺培南耐药929株（44.2%）.Meta分析结果显示,Ⅰ类整合子在铜绿假单胞菌亚胺培南耐药株中的检出率明显高于敏感株[比值比（OR）为4.82,95%可信区间（CI）为2.68-8.66];Ⅰ类整合子检测诊断铜绿假单胞菌亚胺培南耐药的合并敏感性、特异性、阳性似然比、阴性似然比分别为0.73（95%CI为0.70-0.76）、0.64（95%CI为0.61-0.66）、1.90（95%CI为1.47-2.45）、0.47（95%CI为0.35-0.64）,拟合综合受试者工作特征（SROC）曲线下面积（AUC）为0.749 5.结论 Ⅰ类整合子与铜绿假单胞菌亚胺培南耐药相关,Ⅰ类整合子检测对诊断铜绿假单胞菌亚胺培南耐药具有一定价值,建议临床将Ⅰ类整合子检测与其他方法联合使用,以提高其检验效能.Objective To analyze the correlation between Class Ⅰ integron and imipenem resistance of Pseudomonas aeruginosa through Meta-analysis,and evaluate Class Ⅰ integron for diagnosing imipenem resistance of Pseudomonas aeruginosa. Methods The databases,including Chinese Biomedical Literature Database(CBM),China National Knowledge Infrastructure(CNKI),WANFANG,Chinese VIP Database(VIP),Pub Med and Embase,were searched from establishment to December 2015 for Class Ⅰ integron,imipenem resistance and Pseudomonas aeruginosa. Datum selection,extraction and assessment were conducted by 2 reviewers independently according to inclusion and exclusion criteria. Meta-analysis was performed by Rev Man 5.2 and MetaDisc 1.4. Results A total of 24 papers were in accordance with inclusion criteria,which included 2 101 isolates of Pseudomonas aeruginosa isolated from clinical specimens. Among them,1 134 isolates(54.0%) were positive for Class Ⅰ integron,while 929 isolates(44.2%) were resistant to imipenem. Meta-analysis showed that Class Ⅰintegron was more common in imipenem-resistant Pseudomonas aeruginosa than in imipenem-sensitive Pseudomonas aeruginosa [odds ratio(OR) was 4.82,95% confidence interval(CI) was 2.68-8.66]. In the determination of Class Ⅰ integron for diagnosing imipenem resistance of Pseudomonas aeruginosa,the sensitivity,specificity,positive likelihood ratio and negative likelihood ratio were 0.73(95%CI was 0.70-0.76),0.64(95%CI was 0.61-0.66),1.90(95%CI was 1.47-2.45) and 0.47(95%CI was 0.35-0.64),respectively,and the area under summary receiver operating characteristic(SROC) curve(AUC) was 0.749 5. Conclusions Class Ⅰ integron is related to imipenem resistance of Pseudomonas aeruginosa. The determination of Class Ⅰ integron has certain significance in diagnosing imipenem resistance of Pseudomonas aeruginosa. It is suggested to be combined with other clinical methods to improve efficiency.

关 键 词：Ⅰ类整合子 铜绿假单胞菌 亚胺培南耐药 诊断 META分析 

分 类 号：R446.5[医药卫生—诊断学]