降鈣素原對呼吸機相關性肺炎診斷價值的系統評價_《中國循證醫學雜志》

作者：

廖雪蓮 , 鄧一蕓 ,  康焰

四川大學華西醫院重癥醫學科（成都?610041）;

關鍵詞：

降鈣素原呼吸機相關肺炎診斷性試驗系統評價

DOI：

10.7507/1672-2531.20100519

視頻：

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摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的 ?系統評價降鈣素原（PCT）對呼吸機相關性肺炎（VAP）的診斷價值。
方法 ?計算機檢索MEDLINE（1996～2010.1）、EMbase（1974～2010.1）、The Cochrane Library（2010年第1期）、CBM（1978～2010.1）和BIOSIS（1995～2010.1）數據庫，并手檢納入研究的參考文獻，全面收集使用PCT診斷VAP的相關研究。按照QUADAS標準評價納入研究質量后采用Meta-Disk1.4軟件對敏感性、特異性、陽性似然比（+LR）、陰性似然比（–?LR）進行合并分析和異質性檢驗，并繪制綜合受試者特征曲線（SROC）。
結果 ?從103篇文獻中共篩選出5個合格研究，這些研究間存在明顯異質性（I2 gt;50%），其總的敏感性為0.70［95%CI（0.62，0.77）］，特異性為0.76［95%CI（0.69，0.82）］。+LR為5.651［95%CI（1.237，25.810）］，–LR為0.349［95%CI（0.155，0.784）］。SROC曲線下面積（AUC）為0.884［診斷比值比（DOR）=19.416，95%CI（2.473，152.47）］。
結論 ?PCT用于VAP的診斷只有中等程度的敏感性和特異性，雖然總的診斷準確性較高，但各研究間存在較大差異，期待開展更多高質量的研究。其次，單獨使用PCT來診斷VAP存在局限，使用PCT診斷VAP仍需結合具體的臨床情況。

引用本文： 廖雪蓮,鄧一蕓,康焰. 降鈣素原對呼吸機相關性肺炎診斷價值的系統評價. 中國循證醫學雜志, 2010, 10(8): 910-915. doi: 10.7507/1672-2531.20100519 復制

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2.	American Thoracic Society. Infectious Disease Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med, 2005, 171: 388-416.
3.	Safdar N, Dezfulian C, Collard HR, et al. Clinical and economic consequences of ventilator-associated pneumonia: A systematic review. Crit Care Med, 2005, 33: 2184-2193.
4.	Kuti EL, Patel AA, Coleman CI. Impact of inappropriate antibiotic therapy on mortality in patients with ventilator-associated pneumonia and blood stream infection: A meta-analysis. J Crit Care, 2008, 23: 91-100.
5.	Luna CM, Aruj P, Niederman MS. Appropriateness and delay to initiate therapy in ventilator-associated pneumonia. Eur Respir J, 2006, 27, 158-164.
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10.	刑豫賓, 戴路明, 趙芝煥, 等. 血清降鈣素原和常用炎癥指標結合SOFA評分對膿毒癥早期診斷和預后價值的評價. 中國危重病急救醫學, 2008, 20(1): 23-28.
11.	Simon L, Gauvin F, Amre DK, et al. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: A systematic review and meta-analysis. Clin Infect Dis, 2004, 39: 206-217.
12.	Duflo F, Debon R, Monneret G, et al. Alveolar and serum procalcitonin: diagnostic and prognostic value in ventilator-associated pneumonia. Anesthesiology, 2002, 96: 74-79.
13.	周承惇, 陸澤元, 任南征, 等. 降鈣素原在呼吸機相關性肺炎中的診斷價值.中國危重病急救醫學. 2006, 18(6): 370-172.
14.	張智健, 王立萬, 劉長庭, 等. 58例長期機械通氣老年患者血清降鈣素原變化對呼吸機相關性肺炎的診斷意義. 第三軍醫大學學報, 2007, 29(10): 990-991.
15.	Ramlrez P, Garcla, Ferrer M, et al. Sequential measurements of procalcitonin levels in diagnosing ventilator-associated pneumonia. Eur Respir J, 2008, 31: 356-362.
16.	Luyt C, Combes A, Reynaud C, et al. Usefulness of procalcitonin for the diagnosis of ventilator-associated pneumonia. Intensive Care Med, 2008, 34: 1434-1440.
17.	Whiting P, Rutjes AW, Reitsma JB, et a1. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol, 2003, 3: 25．.
18.	Tang BM, Eslick GD, Craig JC, et al. Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. Lancet Infect Dis, 7: 210-227.
19.	Patrick M, Bossuyt JB, Reitsma DE, et al. The STARD statement for reporting studies of diagnosis accuracy: explanation and elaboration. Croat Med J, 2003, 44: 639-650.

1. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med, 2002, 165: 867-903.
2. American Thoracic Society. Infectious Disease Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med, 2005, 171: 388-416.
3. Safdar N, Dezfulian C, Collard HR, et al. Clinical and economic consequences of ventilator-associated pneumonia: A systematic review. Crit Care Med, 2005, 33: 2184-2193.
4. Kuti EL, Patel AA, Coleman CI. Impact of inappropriate antibiotic therapy on mortality in patients with ventilator-associated pneumonia and blood stream infection: A meta-analysis. J Crit Care, 2008, 23: 91-100.
5. Luna CM, Aruj P, Niederman MS. Appropriateness and delay to initiate therapy in ventilator-associated pneumonia. Eur Respir J, 2006, 27, 158-164.
6. Rea-Neto A, Youssef NCM, Tuche F, et al. Diagnosis of ventilator-associated pneumonia: a systematic review of the literature. Crit Care, 2008, 12: R56 (doi:10.1186/cc6877).
7. Lisboa T, Rello J. Diagnosis of ventilator-associated pneumonia: is there a gold standard and a simple approach? Curr Opin Infect Dis, 2008, 21: 174-178.
8. Christ-Crain M, Muller B. Procalcitonin in bacterial infections-hype, hope more or less? Swiss Med Wkly, 2005, 135: 451-460.
9. Uzzan B, Cohen R, Nicolas P, et al. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: A systematic review and meta-analysis. Cril Care Med, 2006, 34: 1996-2003.
10. 刑豫賓, 戴路明, 趙芝煥, 等. 血清降鈣素原和常用炎癥指標結合SOFA評分對膿毒癥早期診斷和預后價值的評價. 中國危重病急救醫學, 2008, 20(1): 23-28.
11. Simon L, Gauvin F, Amre DK, et al. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: A systematic review and meta-analysis. Clin Infect Dis, 2004, 39: 206-217.
12. Duflo F, Debon R, Monneret G, et al. Alveolar and serum procalcitonin: diagnostic and prognostic value in ventilator-associated pneumonia. Anesthesiology, 2002, 96: 74-79.
13. 周承惇, 陸澤元, 任南征, 等. 降鈣素原在呼吸機相關性肺炎中的診斷價值.中國危重病急救醫學. 2006, 18(6): 370-172.
14. 張智健, 王立萬, 劉長庭, 等. 58例長期機械通氣老年患者血清降鈣素原變化對呼吸機相關性肺炎的診斷意義. 第三軍醫大學學報, 2007, 29(10): 990-991.
15. Ramlrez P, Garcla, Ferrer M, et al. Sequential measurements of procalcitonin levels in diagnosing ventilator-associated pneumonia. Eur Respir J, 2008, 31: 356-362.
16. Luyt C, Combes A, Reynaud C, et al. Usefulness of procalcitonin for the diagnosis of ventilator-associated pneumonia. Intensive Care Med, 2008, 34: 1434-1440.
17. Whiting P, Rutjes AW, Reitsma JB, et a1. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol, 2003, 3: 25．.
18. Tang BM, Eslick GD, Craig JC, et al. Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. Lancet Infect Dis, 7: 210-227.
19. Patrick M, Bossuyt JB, Reitsma DE, et al. The STARD statement for reporting studies of diagnosis accuracy: explanation and elaboration. Croat Med J, 2003, 44: 639-650.

《中國循證醫學雜志》

降鈣素原對呼吸機相關性肺炎診斷價值的系統評價

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《中國循證醫學雜志》

降鈣素原對呼吸機相關性肺炎診斷價值的系統評價

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