Huang S-L, Lee H-C, Yu C-W, Chen H-C, Wang C-C, Wu J-Y, Lee C-C
Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan.
Department of Anaesthesiology, Chang Gung Memorial Hospital, Taoyuan, and Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.
Int J Tuberc Lung Dis. 2014 Apr;18(4):470-7. doi: 10.5588/ijtld.13.0449.
To systematically and quantitatively summarise the current evidence on the utility of the procalcitonin test (PCT) in discriminating pulmonary tuberculosis (TB) from other pulmonary infections.
We searched MEDLINE, EMBASE and the Cochrane database up to August 2013 for studies that reported the performance of PCT alone or compared with other biomarkers in diagnosing pulmonary TB. We summarised PCT using forest plots, hierarchical summary receiver operating characteristic curves and bivariate random effects models.
We found nine qualifying studies covering 951 episodes of suspected TB along with 426 confirmed TB cases. The bivariate pooled sensitivity and specificity of PCT to distinguish TB from non-TB were respectively 42% (95%CI 30-56) and 87% (95%CI 63-96). The bivariate pooled sensitivity and specificity for PCT in distinguishing TB from bacterial pneumonia were respectively 78% (95%CI 67-86) and 85% (95%CI 78-90). Low heterogeneity was noted in studies comparing TB with bacterial pneumonia patients.
The results suggest consistently acceptable sensitivity and specificity of the PCT test in distinguishing TB from bacterial pneumonia. However, given the imperfect sensitivity and specificity of the test, medical decisions should be based on both the PCT test results as well as on clinical findings.
系统且定量地总结目前有关降钙素原检测（PCT）在鉴别肺结核（TB）与其他肺部感染方面效用的证据。
我们检索了截至2013年8月的MEDLINE、EMBASE和Cochrane数据库，以查找报告了单独使用PCT或与其他生物标志物相比在诊断肺结核方面表现的研究。我们使用森林图、分层汇总受试者工作特征曲线和双变量随机效应模型对PCT进行了总结。
我们找到了9项符合条件的研究，涵盖951例疑似结核病发作以及426例确诊结核病例。PCT区分结核病与非结核病的双变量合并敏感性和特异性分别为42%（95%CI 30 - 56）和87%（95%CI 63 - 96）。PCT区分结核病与细菌性肺炎的双变量合并敏感性和特异性分别为78%（95%CI 67 - 86）和85%（95%CI 78 - 90）。在比较结核病患者与细菌性肺炎患者的研究中观察到低异质性。
结果表明，PCT检测在区分结核病与细菌性肺炎方面的敏感性和特异性始终可以接受。然而，鉴于该检测的敏感性和特异性并不完美，医疗决策应基于PCT检测结果以及临床发现。
