早产儿生后早期头颅磁共振成像结果预测远期脑性瘫痪价值的meta分析  

作　　者：黄胜[1] 黄托夫[1] 娄普[1] 潘秋飞[1] 陈翔[1] 

机构地区：[1]浙江省温州医学院附属第二医院康复中心,325000

出　　处：《中华围产医学杂志》2012年第3期132-139,共8页Chinese Journal of Perinatal Medicine

摘　　要：目的通过meta分析定量评价早产儿生后早期头颅磁共振成像结果预测远期发生脑性瘫痪的临床价值。方法计算机检索PubMed、Embase、Cochrane、中国生物医学文献数据库、中国期刊全文数据库、维普数据库和万方数据库中关于早产儿头颅磁共振成像结果预测脑性瘫痪的相关文献。纳入标准：（1）研究目的为评价早产儿生后早期头颅磁共振成像结果预测远期神经预后的价值；（2）研究类型为前瞻性的队列研究与随机对照试验以及回顾性的病例分析与病例对照研究；（3）头颅磁共振成像的检查时间窗为小于纠正年龄3个月；（4）脑性瘫痪诊断金标准为随访结果，且诊断标准明确。采用Statall．0统计软件进行meta分析，计算敏感性、特异性、阳性和阴性似然比。结果共纳入7篇英文文献，772例早产儿，发生脑性瘫痪92例。早产儿生后早期头颅磁共振成像结果预测远期发生脑性瘫痪的合并敏感性为0．93（95％CI：0．65～0．99），特异性为0．89（95％CI20．81-O．93），阳性似然比为8．19（95％CI：4．48～14．94），阴性似然比为0．08（95％CI：0．01～0．52），总受试者工作特性曲线下面积为0．95（95％CI：0．92～0．96）。合并值存在明显异质性，差异有统计学意义（P〈o．05）。排除l篇回顾性研究与1篇低发病率文献后异质性显著降低（P）0．10），预测精确性相应有所降低，合并敏感性为0。81（95％CI：0．58～0．93），特异性为0．82（95％CI：0。76～0．87）。结论早产儿生后早期头颅磁共振成像结果预测远期脑性瘫痪的发生可能具有较高的精确性，尤其是对阴性结果，排除价值较高。而对于具有高危因素的早产儿，头颅磁共振成像的阳性结果，预测效率可能更高。Objective To evaluate the value of early brain magnetic resonance imaging (MRI) in predicting future cerebral palsy in premature infants. Methods Searching the related literatures in PubMed,Embase,Cochrane,China Biological Medical Literature Database,China Academic Journal Full-Text Database,VIP Database and Wanfang Database.Inclusion criteria:(1) the purpose of the research was to evaluate the value of early brain MRI in predicting cerebral palsy of premature infants;(2) the type of research was prospective cohort study,randomized controlled trial,retrospective case analysis or case control studies; (3) the inspection was taken within 3 months of correction age; (4)the gold standard in diagnosing cerebral palsy was based on follow-up results,and the diagnosis criteria was clear.The sensitivity,specificity,positive and negative likelihood ratio were calculated and pooled by Stata11.0. Results Seven studies were enrolled into this meta-analysis including 772 premature infants and among which 92 were diagnosed as cerebral palsy.The pooled sensitivity was 0.93 (95％CI:0.65-0.99),specificity was 0.89 (95％CI:0.81-0.93),positive likelihood ratio was 8.19 (95％CI:4.48-14.94) and the negative likelihood ratio was 0.08 (95％CI:0.01-0.52),the area under the summary receiver operating characteristic curve was 0.95 (95％ CI:0.92-0.96).Significant heterogeneity was found (P＜0.05).When one retrospective study and one low morbidity study was removed,heterogeneity reduced significantly (P＞0.10),and predictive accuracy slightly decreased.The pooled sensitivity was 0.81 (95％CI:0.58-0.93 ),specificity was 0.82 (95％CI:0.76-0.87). Conclusions Early brain MRI has high accuracy in predicting future cerebral palsy of premature infant,especially for negative results.And for the premature infants with high risk factors,positive brain MRI result might have a higher predictive efficiency.

关 键 词：头颅磁共振成像 META分析 脑性瘫痪 临床价值 早产儿 中国生物医学文献数据库 预测 早期 

分 类 号：R742.3[医药卫生—神经病学与精神病学]