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目的评价中性粒细胞CD64的不同时间测定结果在新生儿败血症抗感染指征判断中的敏感性和特异性,为新生儿败血症尽早诊断并及时抗感染治疗提供检测依据。方法分别在Pubmed/Medline、Embase、Science Citation Index Expanded等文献数据库中,检索其建库至2013年10月15日发表的有关在不同时间测定中性粒细胞CD64诊断新生儿败血症敏感性和特异性的文献,对其进行质量评估,对符合要求的所有文献研究结果进行Meta分析,评估0~12 h与24~48 h等不同时间分别测定CD64、C反应蛋白(CRP)等指标,用于判断新生儿败血症的敏感性和特异性的优势比(OR)。结果符合纳入标准文献的共有4篇,0~12h与24~48 h分别检测CD64诊断新生儿败血症的敏感性OR=0.37[95%CI(0.20,0.67),P<0.01];特异性OR=1.39[95%CI(0.88,2.21),P=0.164]。0~12 h检测CD64与CRP诊断新生儿败血症的敏感性OR=3.72[95%CI(2.19,6.31),P<0.000 01];特异性OR=0.59[95%CI(0.35,1.00),P=0.05]。0~12 h检测CD64与24~48 h检测CRP诊断新生儿败血症的敏感性OR=2.40[95%CI(1.37,4.21),P=0.002];特异性OR=0.88[95%CI(0.54,1.44),P=0.62]。结论在新生儿败血症的诊断中,24~48 h CD64检测的敏感性优于0~12 h检测;0~12 h CD64检测的敏感性优于0~12 h CRP和24~48 h CRP;0~12 h CRP检测的特异性优于0~12 h CD64;0~12 h CD64与24~48 h CD64或与24~48 h CRP检测相比,诊断新生儿败血症的特异性均无统计学意义。
Objective To evaluate the sensitivity and specificity of neutrophil CD64 assay in judging the indications of anti-infection in neonatal sepsis and to provide the basis for early diagnosis and timely anti-infective treatment of neonatal sepsis. Methods The databases of Pubmed / Medline, Embase, Science Citation Index Expanded and other databases were searched to determine the sensitivity and specificity of neutrophil CD64 in the diagnosis of neonatal sepsis at different time points published on October 15, 2013 respectively. Of the literature, the quality of its assessment of all the literature to meet the requirements of the results of the Meta-analysis to assess the 0 ~ 12 h and 24 ~ 48 h at different times were measured CD64, C-reactive protein (CRP) and other indicators used to determine Sensitivity and specificity of neonatal sepsis odds ratio (OR). Results The results showed that the sensitivity of CD64 in the diagnosis of neonatal sepsis was 0.37 [95% CI (0.20,0.67), P <0.01], and the specificity of OR = 0.37 was between 0 ~ 12h and 24 ~ 1.39 [95% CI (0.88, 2.21), P = 0.164]. The odds of detecting CD64 and CRP for neonatal sepsis at 0-12 h were OR = 3.72 [95% CI (2.19, 6.31), P <0.000 01]; OR = 0.59 [95% CI = 0.05]. The odds ratio (OR = 2.40 [95% CI (1.37, 4.21), P = 0.002]; specificity OR = 0.88 [95% CI (0.54, 1.44), P = 0.62]. Conclusions In the diagnosis of neonatal sepsis, the sensitivity of CD64 detection from 24 to 48 h is better than that from 0 to 12 h; the sensitivity of CD64 from 0 to 12 h is better than that of 0-12 h CRP and 24-48 h CRP The specificity of ~ 12 h CRP detection was better than that of 0 ~ 12 h CD64. There was no significant difference in diagnosis of neonatal sepsis between 0 ~ 12 h CD64 and 24 ~ 48 h CD64 or 24 ~ 48 h CRP .