血小板与淋巴细胞比值对中国川崎病患儿冠状动脉病变预测价值的Meta分析

Platelet-to-lymphocyte ratio as a biomarker for predicting coronary artery lesions in Chinese children with Kawasaki disease: a Meta analysis

摘要:

目的 系统评价血小板与淋巴细胞比值（platelet-to-lymphocyte ratio, PLR）对川崎病（Kawasaki disease, KD）患儿冠状动脉病变（coronary artery lesion, CAL）的预测价值。方法 检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方数据、中国生物医学文献检索数据库、维普数据库等数据库自建库至2022年12月PLR预测中国KD患儿发生CAL的相关研究。采用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale）评价纳入文献的质量，采用Stata 15.1进行Meta分析。结果 共纳入10项研究，包括3 664例中国KD儿童，其中1 328例发生了CAL。Meta分析显示：PLR预测KD患儿发生CAL的灵敏度为0.78（95%CI：0.71~0.83），特异度为0.71（95%CI：0.61~0.80），总诊断比值比为8.69（95%CI：5.02~15.06），拟合受试者操作特征的曲线下面积为0.82（95%CI：0.78~0.85）。亚组分析显示，单独使用PLR预测KD患儿发生CAL的灵敏度、特异度和曲线下面积低于PLR联合其他指标。敏感性分析显示，逐一排除纳入研究后结果无显著变化，提示Meta分析结果稳健。发表偏倚结果显示，纳入的研究存在显著的发表偏倚（P<0.001）。结论 PLR对中国KD患儿CAL的发生有一定的预测价值。

Abstract:

Objective To systematically evaluate the value of the platelet-to-lymphocyte ratio (PLR) in predicting coronary artery lesions (CAL) in Chinese children with Kawasaki Disease (KD).Methods A comprehensive search was conducted in databases including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Data, China Biomedical Literature Database, and China Science and Technology Journal Database from inception to December 2022. The quality of the included literature was assessed using the Newcastle-Ottawa Scale, and a Meta analysis was performed using Stata 15.1.Results A total of ten published reports, involving 3 664 Chinese children with KD, were included in this Meta analysis, of whom 1 328 developed CAL. The Meta analysis revealed a sensitivity of 0.78 (95%CI: 0.71-0.83), specificity of 0.71 (95%CI: 0.61-0.80), overall diagnostic odds ratio of 8.69 (95%CI: 5.02-15.06), and an area under the curve of the summary receiver operating characteristic of 0.82 (95%CI: 0.78-0.85) for PLR in predicting CAL in the children with KD. The sensitivity, specificity, and area under the curve of summary receiver operating characteristic were lower for PLR alone compared to PLR in combination with other indicators. Sensitivity analysis demonstrated the stability of the Meta analysis results with no significant changes upon excluding individual studies. However, a significant publication bias was observed (P<0.001).Conclusions PLR demonstrates certain predictive value for CAL in Chinese children with KD.