多排螺旋CT血管造影对颈动脉狭窄诊断价值的Meta分析  

CT angiography in the diagnosis of carotid artery stenosis:a Meta analysis

作　　者：贺丽英[1] 钱晓军[1] 吕秀华[1] 闫玉昌[1] 

机构地区：[1]首都医科大学附属北京朝阳医院放射科(西区),100043

出　　处：《中华临床医师杂志（电子版）》2012年第3期86-90,共5页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的对以数字减影血管造影(DSA)为金标准,研究多排螺旋CT血管造影(MSCTA)诊断颈动脉狭窄的文献进行Meta汇总分析,评价MSCTA对颈动脉狭窄的临床诊断价值。方法检索Cochrane图书馆、PubMed、OVID循证医学数据库、中国期刊网中的英文和中文文献,按照Cochrane协作网推荐的诊断试验的纳入标准筛选文献,并对纳入文献进行质量评估,提取纳入研究的特征信息。数据分析采用Meta-DiSc1.4软件,检验异质性,并根据异质性结果选择相应的效应模型。对所有研究进行加权定量合并,按临床狭窄程度分组计算灵敏度、特异度及其95%可信区间。绘制汇总受试者工作特征曲线(SROC),并计算曲线下面积。结果共纳入7篇文献,均存在异质性。按照随机效应模型计算MSCTA诊断颈动脉狭窄率0～49%组的汇总灵敏度、汇总特异度及95%可信区间分别为0.87(0.82～0.91)、0.97(0.94～0.99);50%～69%组的汇总灵敏度、汇总特异度及95%可信区间分别为0.77(0.67～0.86)、0.95(0.92～0.97);70%～99%组的汇总灵敏度、汇总特异度及95%可信区间分别为0.92(0.86～0.96)、0.93(0.89～0.95)。MSCTA诊断颈动脉狭窄率0～49%组、50%～69%组、70%～99%组的SROC曲线下面积分别为:98.36%、90.01%、98.47%。结论汇总目前关于MSCTA诊断颈动脉狭窄的研究显示,MSCTA是一种灵敏度和特异度较高的无创性检查方法 ,值得临床推广。Objective To assess the overall diagnostic value of multi-slice spiral computed tomography angiography（MSCTA）in patients with suspected carotid artery stenosis with the digital subtraction angiography as the gold standard.Methods A search in Cochrane Library,PubMed,OVID,and CNKI was performed to identify relevant English and Chinese language articles.Criteria for inclusion were established based on validity criteria for diagnostic research published by the Cochrane Methods Group on screening and diagnostic tests.Subsequently,the characteristics of the included articles were appraised and extracted.Statistical analysis was performed employing Meta-DiSc 1.4.Heterogeneity of the included articles was tested,which was used to select proper effect model to calculate pooled weighted sensitivity and specificity.Summary Receiver Operating Characteristic（SROC）curve was performed and the area under the curve（AUC）was calculated.Results 7 of 398 retrieved articles were included.The pooled weighted sensitivity and specificity with 95% confidence interval（95% CI）for 0-49% were 0.87（0.82-0.91）and 0.97（0.94-0.99）,respectively.The pooled weighted sensitivity and specificity with 95% CI for 50%-69% were 0.77（0.67-0.86）and 0.95（0.92-0.97）,respectively.The pooled weighted sensitivity and specificity with 95% CI for 70%-99% were 0.92（0.86-0.96）and 0.93（0.89-0.95）,respectively.The AUC of SROC for the three groups were 98.36%,90.01%,98.47%,respectively.Conclusions MSCTA has a highly accurate sensitivity and specificity with a strong ROC curve making it an alternative non-invasive method in the diagnosis of carotid artery stenosis and is worthy of promotion.

关 键 词：颈动脉狭窄 体层摄影术 X线计算机 META分析 

分 类 号：R816.2[医药卫生—放射医学]