磁共振肺动脉造影对肺动脉栓塞诊断价值的Meta分析  

Magnetic Resonance Pulmonary Angiography in Detection of Pulmonary Emblism: A Meta-analysis

作　　者：张有志[1] 夏敬文[1] 杨海华[1] 龙丰[1] 陈小东[1] 

机构地区：[1]复旦大学附属华山医院,上海200040

出　　处：《中国呼吸与危重监护杂志》2013年第5期499-504,共6页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的应用Meta分析法综合评价磁共振肺动脉造影（MRA）诊断急性肺栓塞（PE）的价值。方法在Cochrane图书馆、Medline和Embase数据库和万方、中国生物医学文献数据库检索1990年1月至2012年12月发表的相关英文和中文文献；根据Cochrane协作网推荐的诊断试验的纳入标准筛选符合条件的文献，对文献进行信息统计、科学性评估及质量分级，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，根据异质性检验结果选择相应的效应模型进行数据分析；通过汇总似然比（LR），汇总敏感度和特异度及汇总受试者工作特征曲线（SROC曲线）等统计指标综合评价MRA在PE中的诊断价值。结果共纳入6篇英文文献，534例研究对象。异质性检验提示有阈值效应，按随机效应模型进行Meta分析得出MRA在PE中诊断价值的汇总阳性似然比为32．392（15．951～65．778），汇总阴性似然比为0．217（0．160～0．294），汇总敏感度为0．800（0．728—0．860），汇总特异度为0．984（0．966～0．994），SROC曲线下面积（AUC）为0．9783。结论MRA是诊断肺栓塞有价值的方法，特别适用于有肾功能不全和造影剂过敏的患者，此外还可避免放射线暴露。Objective To assess the overall diagnostic value of magnetic resonance angiography （MRA） in patients with suspected pulmonary embolism. Methods A search in Cochrane Library, Medline, Embase,Wanfang and China Biology Medicine disc （CBMdisc） was performed to identify relevant English and Chinese language publications from 1990 to 2012. Criteria for inclusion was 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 by Meta-disc version 1.4. Heterogeneity of the included articles was tested, which was used to select proper effect model to calculate pooled weighted sensitivity, specificity, positive likelihood ratio and negative likelihood ratio. Summary receiver opertating characteristic （SROC） curve was performed and the area under the curve （AUC） was calculated. Results 6 literatures in English were finally collected,with a total of 534 cases recruited into the study. Heterogeneity was found because of threshold effect. A Meta- analysis was performed using the random effect model. The value of the positive likelihood ratio and negative likelihood ratio of MRA with 95% confidence interval （95% CI） were 32. 392（ 15. 951-65. 778） and 0. 217 （0. 160-0. 294）, respectively. The pooled weighted sensitivity and specificity were 0. 800 （0. 728-0. 860） and 0. 984（0. 966-0. 994） ,respectively. The AUC of SROC was 0. 9783. Conclusions MRA has certain diagnosis value for pulmonary embolism with high sensitivity and specificity. MRA may be the best choice for some patients with renal mysfunction and allergy to radiographic contrast material. Otherwise, patients who are detected by MRA avoid exposure to ionizeing radiation.

关 键 词：磁共振血管造影 肺栓塞 META分析 

分 类 号：R563.5[医药卫生—呼吸系统]