多层螺旋CT鉴别冠状动脉脂质与纤维斑块的Meta分析  

Meta analysis of MSCT value in differentiating coronary fatty from fibrous plaques

作　　者：李云娟[1] 朱砚[1] 祁吉[2] 

机构地区：[1]解放军第254医院放射科,天津300142 [2]天津市第一中心医院放射诊断科

出　　处：《实用放射学杂志》2012年第9期1338-1344,共7页Journal of Practical Radiology

摘　　要：目的 利用Meta分析评价多层螺旋CT（MSCT）在分析冠状动脉斑块性质中的临床价值.方法 检索Cochrane图书馆,MEDLINE,Pubmed,OVID,Springer,Embase,Sciencedirect,中国生物医学文献数据库、中国学术期刊网全文数据库等的相关中外文文献,按照Cochrane协作网推荐的诊断性试验纳入标准筛选全部检索文献,对纳入文献进行质量评价,分析异质性检验,汇总灵敏度（sensitivity）、特异度（specificity）、阳性似然比（PLR）、阴性似然比（NLR）、诊断比值比（DOR）,绘制受试者工作特征曲线（SROC）和计算曲线下面积（AUC）及稳定性和实用性,综合评价MSCT鉴别冠状动脉脂质斑块与纤维斑块的价值.结果 汇总的冠状动脉脂质斑块与纤维斑块CT值加权均数差值、Sensitivity,Specificity,PLR,NLR,DOR,AUC及其95%可信区间分别为：-53.31 HU （-64.56～-42.05 HU）,0.86 （0.82～0.89）,0.86 （0.83～0.89）,5.98 （4.63～7.72）,0.18 （0.12～0.29）,39.43 （19.43～80.01）,0.93 （0.90～0.96）.选择合理的阈值,CT值提示的脂质斑块验后为脂质斑块的概率为84.18%,验后为纤维斑块的概率为13.79%;CT值提示的纤维斑块验后为纤维斑块的概率为87.11%,验后为脂质斑块的概率为16.67%.结论 冠状动脉脂质斑块CT值低于纤维斑块CT值,MSCT成像应用CT值鉴别冠状动脉脂质斑块与纤维斑块的灵敏度与特异度较高,结果可靠,具有很高的临床应用价值.Objective To discuss multi-slice spiral CT wdue in differentiating coronary artery fatty from fibrous plaques by Meta analysis. Methods The literatures about coronary fatty and fibrous plaques published were researched from Cochrane library,MEDIANE, Pubmed, （）VII）, Springer, Embase, Sciencedirect, Chinese biomedical literature database and Chinese academic journal database by the Coehrane methods group on screening and diagnostic tests. Subsequently, the characteristics of the included articles were appraised and extracted. Statistical analysis was performed employing Meta analysis package. Heterogenetity of the included articles was tested, which was used to select proper effect model to calculate the pooled weighted mean difference, sensitivity, specificity, positiw, likelihood ratio（PLR） ,negative likelihood ratio（NLR） and diagnostic odds ratio（DOR）. Results The weighted mean difference between fatty and fibrous plaques, pooled sensitivity, specificity, PLR, NI.R, DOR,area under curve（AUC） and 95% confidence interval were -53.31 HU （-64.56～-42.05 HU）,0.86 （0.82～0.89）,0.86 （0.83～0.89）,5.98 （4.63～7.72）,0.18 （0.12～0.29）,39.43 （19.43～80.01）,0.93 （0.90～0.96） ,respectively. Theposttest fatty plaque probability of fatty plaqueindica ted by CT value was 84. 18%, while that of fibrous one was 13.79%,The posttest fibrous plaque probahility of fibrous plaque indi eared by CT value was 87. 11 %, while that of fatty one was 16.67%. Conclusion CT attenuation of fatty plaque is generally below that of fibrous plaque,MSCT angiography is a high accurate and untraumal method,which can be used for differentiating the fatty plaque from fibrous plaque with high sensitivity and specificity.

关 键 词：冠状动脉 脂质斑块 纤维斑块 体层摄影术 X线计算机 

分 类 号：R543.3[医药卫生—心血管疾病] R814.42[医药卫生—内科学]