Xie Yan-Qiu, Ren Chang-Jun, Wang Xiong, Xiang Shu-Wen, Wang Xiao-Xing, Hao Ling
Department of Pediatrics, First Hospital of Hebei Medical University, Shijiazhuang 050030, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2021 Apr;23(4):381-389. doi: 10.7499/j.issn.1008-8830.2010111.
To study the value of fecal calprotectin (FC) in the diagnosis of neonatal necrotizing enterocolitis (NEC) through a Meta analysis.
Web of Science, Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure, Weipu Periodical Database, Wanfang Data, Chinese Biomedical Literature Database were searched for related studies published up to May 2020, with manual search as supplementation. The QUADAS criteria were used to evaluate the quality of the articles included. Meta-DiSc 1.4 and Stata 15.0 software were used to perform the Meta analysis, including the evaluation of specificity, sensitivity, likelihood ratio, and diagnostic odds ratio. The sensitivity analysis and heterogeneity testing were performed, and the summary receiver operating characteristic (SROC) curve and Fagan diagram were plotted.
A total of 15 articles were enrolled, involving 1 719 neonates. Among these articles, 4 had low quality, 2 had high quality, and the rest had medium quality. There was high heterogeneity between studies, and there was no threshold effect or publication bias. The random effects model analysis showed that FC had a pooled specificity of 0.80 (95%:0.78-0.82) and a sensitivity of 0.86 (95%:0.83-0.89) in the diagnosis of NEC, with a negative likelihood ratio of 0.19 (95%:0.14-0.26), a positive likelihood ratio of 4.71 (95%:3.57-6.23), and a diagnostic odds ratio of 29.56 (95%:17.98-48.61). The area under the SROC curve was 0.9131 and the index was 0.8456. The Fagan diagram showed that the post-test probability of NEC indicated by negative FC was 13%, while that indicated by positive FC was 86%. The Meta regression analysis showed that the heterogeneity came from other non-threshold factors.
FC has high potential and efficiency in the early diagnosis of NEC. FC measurement can be used for the diagnosis of NEC, but it should be combined with clinical manifestations and other related laboratory examinations.
通过Meta分析研究粪便钙卫蛋白（FC）在新生儿坏死性小肠结肠炎（NEC）诊断中的价值。
检索Web of Science、Cochrane图书馆、PubMed、Embase、中国知网、维普期刊数据库、万方数据、中国生物医学文献数据库中截至2020年5月发表的相关研究，并辅以手工检索。采用QUADAS标准评估纳入文章的质量。使用Meta-DiSc 1.4和Stata 15.0软件进行Meta分析，包括特异性、敏感性、似然比和诊断比值比的评估。进行敏感性分析和异质性检验，并绘制总结性受试者工作特征（SROC）曲线和Fagan图。
共纳入15篇文章，涉及1719例新生儿。其中，4篇质量低，2篇质量高，其余质量中等。研究间存在高度异质性，且无阈值效应或发表偏倚。随机效应模型分析显示，FC诊断NEC的合并特异性为0.80（95%：0.78 - 0.82），敏感性为0.86（95%：0.83 - 0.89），阴性似然比为0.19（95%：0.14 - 0.26），阳性似然比为4.71（95%：3.57 - 6.23），诊断比值比为29.56（95%：17.98 - 48.61）。SROC曲线下面积为0.9131， 指数为0.8456。Fagan图显示，FC阴性提示NEC的验后概率为13%，而FC阳性提示的验后概率为86%。Meta回归分析显示，异质性来自其他非阈值因素。
FC在NEC的早期诊断中具有较高的潜力和效率。FC检测可用于NEC的诊断，但应结合临床表现及其他相关实验室检查。
