外周血IL-6对新生儿脓毒症诊断价值的Meta分析

胡婧, 都鹏飞, 贝丹丹

中国当代儿科杂志 ›› 2015, Vol. 17 ›› Issue (11) : 1176-1182.

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中国当代儿科杂志 ›› 2015, Vol. 17 ›› Issue (11) : 1176-1182. DOI: 10.7499/j.issn.1008-8830.2015.11.006
论著·临床研究

外周血IL-6对新生儿脓毒症诊断价值的Meta分析

  • 胡婧, 都鹏飞, 贝丹丹
作者信息 +

Diagnostic value of interleukin 6 for neonatal sepsis: a Meta analysis

  • HU Jing, DU Peng-Fei, BEI Dan-Dan
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摘要

目的 系统评价外周血IL-6对新生儿脓毒症的诊断价值。方法 通过计算机检索中国知网、维普、万方、PubMed、Embase、Web of Science、Cochrane 图书馆公开发表的有关文献,检索时间截止至2014年9月。采用QUADAS量表对纳入文献进行质量评估;采用Metadisc1.4及Stata11.0软件进行异质性检验并根据异质性结果选择相应的效应模型进行定量合成;计算敏感度、特异度及其95%CI,绘制汇总受试者工作特征曲线(SROC),并计算曲线下面积(AUC)及Q*指数。结果 共计33篇文献纳入Meta分析,分析结果显示:外周血IL-6对新生儿脓毒症诊断的敏感度和特异度分别为0.79(95%CI:0.76~0.81)和0.83(95%CI:0.81~0.85),SROC的AUC为0.89,Q*指数为0.83;IL-6不增高时新生儿脓毒症发生概率为5%,IL-6增高时新生儿脓毒症发生概率提高为60%。结论 外周血IL-6对新生儿脓毒症诊断的敏感度和特异度较高,有助于早期诊断新生儿脓毒症。

Abstract

Objective To evaluate the diagnostic value of interleukin 6 for neonatal sepsis. Methods The databases of CNKI, VIP, Wangfang, Pubmed, Embase, Web of Science, Cochrane Library were searched (by September 2014) to identify relevantly published studies about estimating the diagnostic value of interleukin 6 for neonatal sepsis. QUADAS tools were used for quality evaluation of the studies. A Meta analysis was performed by employing Meta Disc 1.4 and Stata11.0 software. Heterogeneity of the included articles was tested to select proper efficacy model for calculating pooled weighted sensitivity, specificity and 95%CI. Summary receiver operating characteristic (SROC) curve was made and the area under the curve and Q* index were calculated. Results A total of 33 studies including 3 135 neonates were enrolled. The sensitivity and specificity of interleukin 6 for the diagnosis of neonatal sepsis were 0.79 (95%CI: 0.76-0.81) and 0.83 (95%CI: 0.81-0.85) respectively. The area under SROC curve of interleukin 6 for the diagnosis of neonatal sepsis was 0.89 and Q* index was 0.83. The post-test probability of diagnosing neonatal sepsis indicated by negative interleukin 6 was 5%, while that of positive interleukin 6 was 60%. Conclusions Interleukin 6 measurement is useful for the diagnosis of neonatal sepsis with a high sensitivity and specificity.

关键词

脓毒症 / 白介素6 / 诊断 / Meta分析 / 新生儿

Key words

Sepsis / Interleukin 6 / Diagnosis / Meta analysis / Neonate

引用本文

导出引用
胡婧, 都鹏飞, 贝丹丹. 外周血IL-6对新生儿脓毒症诊断价值的Meta分析[J]. 中国当代儿科杂志. 2015, 17(11): 1176-1182 https://doi.org/10.7499/j.issn.1008-8830.2015.11.006
HU Jing, DU Peng-Fei, BEI Dan-Dan. Diagnostic value of interleukin 6 for neonatal sepsis: a Meta analysis[J]. Chinese Journal of Contemporary Pediatrics. 2015, 17(11): 1176-1182 https://doi.org/10.7499/j.issn.1008-8830.2015.11.006

参考文献

[1] Weston EJ, Pondo T, Lewis MM, et al. The burden of invasive early-onset neonatal sepsis in the United States, 2005-2008[J]. Pediatr Infect Dis J, 2011, 30(11): 937-941.
[2] Gerdes JS. Diagnosis and management of bacterial infections in the neonate[J]. Pediatr Clin North Am, 2004, 51(4): 939-959.
[3] Adib-Conquy M, Cavaillon JM. Stress molecules in sepsis and systemic inflammatory response syndrome[J]. FEBS Lett, 2007, 581(19): 3723-3733.
[4] Palmiere C, Augsburger M. Markers for sepsis diagnosis in the forensic setting: state of the art[J]. Croat Med J, 2014, 55(2): 103-114.
[5] Whiting P, Rutjes AW, Reitsma JB, et al. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews[J]. BMC Med Res Methodol, 2003, 3: 25.
[6] Fagan TJ. Nomogram for Bayes theorem[J]. N Engl J Med, 1975, 293(5): 257.
[7] Tunc T, Cekmez F, Cetinkaya M, et al. Diagnostic value of elevated CXCR4 and CXCL12 in neonatal sepsis[J]. J Matern Fetal Neonatal Med, 2014: 1-6.
[8] Boskabadi H, Maamouri G, Afshari JT, et al. Evaluation of serum interleukins-6, 8 and 10 levels as diagnostic markers of neonatal infection and possibility of mortality[J]. Iran J Basic Med Sci, 2013, 16(12): 1232-1237.
[9] Prashant A, Vishwanath P, Kulkarni P, et al. Comparative assessment of cytokines and other inflammatory markers for the early diagnosis of neonatal sepsis-a case control study[J]. PLoS One, 2013, 8(7): e68426.
[10] 金胜鑫, 石海矾, 李伟. 血清降钙素原与超敏C反应蛋白及白介素6在新生儿早期感染中的诊断价值[J]. 中华医院感染学杂志, 2013, 23(7): 1600-1601, 1637.
[11] Abdollahi A, Shoar S, Nayyeri F, et al. Diagnostic value of simultaneous measurement of procalcitonin, interleukin-6 and hs-CRP in prediction of early-onset neonatal sepsis[J]. Mediterr J Hematol Infect Dis, 2012, 4(1): e2012028.
[12] Batfalsky A, Lohr A, Heussen N, et al. Diagnostic value of an interleukin-6 bedside test in term and preterm neonates at the time of clinical suspicion of early- and late-onset bacterial infection[J]. Neonatology, 2012, 102(1): 37-44.
[13] Oncel MY, Dilmen U, Erdeve O, et al. Proadrenomedullin as a prognostic marker in neonatal sepsis[J]. Pediatr Res, 2012, 72(5): 507-512.
[14] 戴标. IL-6、CRP和CD64在新生儿感染性疾病诊断中的价值[J]. 江苏大学学报(医学版), 2012, 22(5): 434-436.
[15] Cekmez F, Canpolat FE, Cetinkaya M, et al. Diagnostic value of resistin and visfatin, in comparison with C-reactive protein, procalcitonin and interleukin-6 in neonatal sepsis[J]. Eur Cytokine Netw, 2011, 22(2): 113-117.
[16] Labenne M, Lizard G, Ferdynus C, et al. A clinic-biological score for diagnosing early-onset neonatal infection in critically ill preterm infants[J]. Pediatr Crit Care Med, 2011,12(2):203-209.
[17] Celik IH, Demirel FG, Uras N, et al. What are the cut-off levels for IL-6 and CRP in neonatal sepsis?[J]. J Clin Lab Anal, 2010, 24(6): 407-412.
[18] Dilli D, Oguz SS, Dilmen U, et al. Predictive values of neutrophil CD64 expression compared with interleukin-6 and C-reactive protein in early diagnosis of neonatal sepsis[J]. J Clin Lab Anal, 2010, 24(6): 363-370.
[19] Sarafidis K, Soubasi-Griva V, Piretzi K, et al. Diagnostic utility of elevated serum soluble triggering receptor expressed on myeloid cells (sTREM)-1 in infected neonates[J]. Intensive Care Med, 2010, 36(5): 864-868.
[20] 解晶, 喻长法, 戴卫峰. 白细胞介素-6、降钙素原和C-反应蛋白联合检测在新生儿败血症早期诊断中的价值[J]. 中华医院感染学杂志, 2010, 20(22): 3628-3629.
[21] 刘德贝, 曹艳林, 邹飞扬, 等. 超敏CRP、IL-6及PCT对新生儿脓毒症早期诊断的意义[J]. 国际检验医学杂志, 2010, 31(3): 212-213, 216.
[22] 陈小琴, 陈云. 血清IL-6、CRP、PCT水平对新生儿败血症的诊断价值[J]. 山东医药, 2009, 49(47): 1-3.
[23] 郭艳, 刘海樱, 曹兆兰, 等. PCT、IL-6、CRP在早期诊断极低出生体重儿败血症中的意义[J]. 现代预防医学, 2009, 36(22): 4240-4242.
[24] Bender J, Thaarup J, Varming K, et al. Early and late markers for the detection of early-onset neonatal sepsis[J]. Dan Med Bull, 2008, 55(4): 219-223.
[25] Kocabas E, Sarikcioglu A, Aksaray N, et al. Role of procalcitonin, C-reactive protein, interleukin-6, interleukin-8 and tumor necrosis factor-alpha in the diagnosis of neonatal sepsis[J]. Turk J Pediatr, 2007, 49(1): 7-20.
[26] Ng PC, Li K, Chui KM, et al. IP-10 is an early diagnostic marker for identification of late-onset bacterial infection in preterm infants[J]. Pediatr Res, 2007, 61(1): 93-98.
[27] Verboon-Maciolek MA, Thijsen SFT, Hemels MAC, et al. Inflammatory mediators for the diagnosis and treatment of sepsis in early infancy[J]. Pediatr Res, 2006, 59(3): 457-461.
[28] Gonzalez BE, Mercado CK, Johnson L, et al. Early markers of late-onset sepsis in premature neonates: clinical, hematological and cytokine profile[J]. J Perinat Med, 2003, 31(1): 60-68.
[29] Laborada G, Rego M, Jain A, et al. Diagnostic value of cytokines and C-reactive protein in the first 24 hours of neonatal sepsis[J]. Am J of Perinatol, 2003, 20(8): 491-501.
[30] Resch B, Gusenleitner W, Muller WD. Procalcitonin and interleukin-6 in the diagnosis of early-onset sepsis of the neonate[J]. Acta Paediatr, 2003, 92(2): 243-245.
[31] Santana RC, Garcia-Munoz F, Reyes D, et al. Role of cytokines (interleukin-1beta, 6, 8, tumour necrosis factor-alpha, and soluble receptor of interleukin-2) and C-reactive protein in the diagnosis of neonatal sepsis[J]. Acta Paediatr, 2003, 92(2): 221-227.
[32] 陆中权, 张信良, 林忠东, 等. 早期诊断极低出生体重儿细菌性感染的实验室指标评价[J]. 中华儿科杂志, 2002, 40(11): 686-689.
[33] Martin H, Olander B, Norman M. Reactive hyperemia and interleukin 6, interleukin 8, and tumor necrosis factor-alpha in the diagnosis of early-onset neonatal sepsis[J]. Pediatrics, 2001, 108(4): E61.
[34] Mehr SS, Doyle LW, Rice GE, et al. Interleukin-6 and interleukin-8 in newborn bacterial infection[J]. Am J Perinatol, 2001, 18(6): 313-324.
[35] Heches X, Pignol M, Van Ditzhuyzen O, et al. Interleukin-6 and interleukin-8 as useful parameters for the early diagnosis of neonatal bacterial infection[J]. Immuno-Analyse et Biologie Specialisee, 2000, 15(5): 346-353.
[36] Kallman J, Ekholm L, Eriksson M, et al. Contribution of interleukin-6 in distinguishing between mild respiratory disease and neonatal sepsis in the newborn infant[J]. Acta Paediatr, 1999, 88(8): 880-884.
[37] Silveira RC, Procianoy RS. Evaluation of interleukin-6, tumour necrosis factor-alpha and interleukin-1beta for early diagnosis of neonatal sepsis[J]. Acta Paediatr, 1999, 88(6): 647-650.
[38] Kuster H, Weiss M, Willeitner AE, et al. Interleukin-1 receptor antagonist and interleukin-6 for early diagnosis of neonatal sepsis 2 days before clinical manifestation[J]. Lancet, 1998, 352(9136): 1271-1277.
[39] Ng PC, Cheng SH, Chui KM, et al. Diagnosis of late onset neonatal sepsis with cytokines, adhesion molecule, and C-reactive protein in preterm very low birthweight infants[J]. Arch Dis Child Fetal Neonatal Ed, 1997, 77(3): F221-F227.
[40] 中华医学会儿科学分会新生儿学组, 编辑委员会中华医学会中华儿科杂志. 新生儿败血症诊疗方案[J]. 中华儿科杂志, 2003, 41(12): 897-899.
[41] Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012[J]. Crit Care Med, 2013, 41(2): 580-637.
[42] Du Pont-Thibodeau G, Joyal JS, Lacroix J. Management of neonatal sepsis in term newborns[J]. F1000Prime Rep, 2014, 6: 67.
[43] Ahmed Z, Ghafoor T, Waqar T, et al. Diagnostic value of C- reactive protein and haematological parameters in neonatal sepsis[J]. J Coll Physicians Surg Pak, 2005, 15(3): 152-156.
[44] Bouyahia O, Ncibi N, Fedhila F, et al. Value of procalcitonin measurement in maternal fetal infection[J]. Tunis Med, 2009, 87(3): 191-195.

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