C反應蛋白在自發性細菌性腹膜炎中診斷價值的Meta分析

鄭州大學第五附屬醫院消化內科，河南 鄭州 450000

【Abstract】ObjectiveTo evaluate the diagnostic value of peripheral blood C-reactive protein (CRP) in patients with spontaneous bacterial peritonitis (SBP).MethodsPubMed, Embase, Web of Science, Cochrane Library, CNKI full-text database, VIP Chinese Science and Technology Journals full-text database, CBM and Wanfang Sci-tech periodicals full-text database related literature on the diagnostic value of CRP in SBP were searched, retrieval time from building to Nov. 2017 and traced references incorporated into the literature. Two researchers independently screened the literature, extracted data and quality evaluation according to inclusion and exclusion criteria, and used QUADAS scale to assess the quality of the included documents, the heterogeneity test was carried out on the included literature by Stata 14.0 and the corresponding effect model was selected according to the heterogeneity results for quantitative synthesis. Calculate sensitivity, specificity, and 95%CI, draw summary receiver operating characteristic curve (SROC), and calculated the area under the curve (AUC) andQ*index.ResultsA total of 16 articles were included for a total of 1 657 patients. Analysis results showed that the sensitivity and specificity of CRP in the diagnosis of SBP were 0.80 (95%CI: 0.77-0.83) and 0.73 (95%CI: 0.70-0.76), respectively.AUCofSROC=0.8542,Q*index was 0.7851.ConclusionThe sensitivity and specificity of CRP in the diagnosis of SBP in cirrhosis are higher, which may be help for the diagnosis of SBP.

【Keywords】 C-reactive protein; Cirrhosis; Spontaneous bacterial peritonitis; Diagnosis; Meta-analysis

自發性細菌性腹膜炎(spontaneous bacterial peritonitis，SBP)是指在無腹腔內鄰近器官直接細菌感染的情況下原發于腹腔的感染，致病菌可以經過機體的淋巴系統、腸道及血液到達腹腔，是重癥肝炎患者和肝硬化失代償期患者常見的嚴重并發癥。SBP既可使原發肝臟疾病迅速惡化，也可導致肝性腦病和肝腎綜合征，病死率為48%～57%。臨床上肝硬化及重癥肝炎并發SBP可通過臨床癥狀、腹水常規檢查、細菌培養而確診，但有部分患者臨床癥狀、腹水檢查不典型，細菌培養陽性率低且所需時間較長，早期診斷困難。研究表明，細菌感染者血中C反應蛋白(C-reactive protein, CRP)會明顯升高，是臨床重癥感染的監測指標。目前已有多項國內外研究對外周血CRP水平診斷SBP的價值進行了討論，但結果并不統一。為此，本研究檢索外周血CRP水平診斷SBP的相關文獻，采用Meta分析方法進行定量合并，為臨床早期診斷SBP提供依據。

1 資料與方法

1.1資料來源檢索PubMed、Embase、Web of Science、Cochrane Library、中國學術期刊(CNKI)全文數據庫、維普(VIP)中文科技期刊全文數據庫、中國生物醫學文獻數據庫(CBM)和萬方科技期刊全文數據庫。英文檢索詞為：C-reactive protein、C reactive protein、CRP、spontaneous bacterial peritonitis、SBP等，中文檢索詞為：C反應蛋白、自發性細菌性腹膜炎等，檢索時間截至2017年11月，無語言限制，同時對相關文獻進行必要的參考文獻檢索以避免漏檢文獻。

1.2文獻篩選標準文獻篩選依據Cochrane協作網關于診斷實驗性研究的納入標準進行篩選，納入標準為：(1)研究對象為肝硬化或重癥肝炎SBP患者的前瞻性或回顧性中、英文文獻；……