脉搏血氧仪筛查儿童亚临床先天性心脏病准确性的系统评价和Meta分析  

Pulse Oximetry Screening for Congenital Heart Disease in Asymptomatic Children:A Systematic Review and Meta-Analysis

作　　者：尤涛[1] 刘兴光[1] 王新宽[1] 侯小东[1] 丁凡[1] 丁兆红[1] 张臣[1] 移康[1] 

机构地区：[1]甘肃省人民医院心血管外科,兰州730000

出　　处：《中国胸心血管外科临床杂志》2013年第6期691-697,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：甘肃省自然科学研究基金计划(2010GS05162)~~

摘　　要：目的评价脉搏血氧饱和度测定诊断儿童亚临床先天性心脏病的准确性。方法制定详细的检索策略,计算机检索建库至2013年2月间维普中文科技期刊数据库、中国期刊全文数据库、中国生物医学文献数据库、万方数据库、PubMed、Excerpta Medica Database、The Cochrane Library,纳入脉搏血氧仪用于筛查儿童亚临床先天性心脏病的相关研究,两名研究者背对背提取有效数据,以诊断性研究质量评价标准(QUADAS)评价文献质量,应用RevMan 5.1.1软件进行Meta分析。结果最终纳入12个研究,共包括137 582例新生儿。12个研究均符合QUADAS 14条,12个研究中,只有待评价试验结果阳性的样本接受了金标准试验;12个研究中仅有1个研究描述了金标准试验的操作,有10篇文献是在知晓待评价试验结果的情况下进行的金标准试验结果判读。Meta分析结果显示:脉搏血氧仪诊断先天性心脏病的合并敏感度和特异度分别为22%[95%CI(19%,25%)]、99%[95%CI(99%,99%)],合并阳性似然比和阴性似然比分别为157.30[95%CI(11.80,2 096.95)]、0.61[95%CI(0.46,0.82)],合并诊断比值比为398.25[95%CI(34.5,4 596.81)],受试者工作特征(SROC)曲线下面积为0.809,Q*指数为0.744。结论脉搏血氧仪用于诊断儿童先天性心脏病的敏感度较低,而特异度较高,有助于早期诊断先天性心脏病。Objective To investigate the accuracy of pulse oximetry screening for congenital heart disease （CHD） in asymptomatic children. Methods We electronically searched VIP database,CNKI database,CBMdisc,Wanfandatabase,PubMed,Excerpta Medica Database （EMBASE） and the Cochrane Library from the time of database establishment to February 2013 to identify literatures regarding pulse oximetry screening for CHD in asymptomatic children. Data extraction was performed by two researchers independently. Quality of the included literatures was evaluated with qualityassessment for diagnostic accuracy studies （QUADAS）. Meta-analysis was performed using RevMan 5.1.1. ResultsTwelve studies were included in this study with a total of 137 582 newborns. Fourteen QUADAS criteria were fulfilled by all the 12 studies. Among the 12 studies,only the studies with positive test results received verification using a gold standardtest,and the execution of the gold standard test was described in sufficient detail only in 1 study. There were 10 studies in which the gold standard test results were interpreted with knowledge of the diagnostic test results. Meta-analysis showed that pooled sensitivity and specificity of pulse oximetry test for the diagnosis of CHD were 22% with 95% CI （19%,25%） and 99% （99%,99%） respectively. Pooled positive likelihood ratio （LR＋） and negative likelihood ratio （LR-） were 157.30 with 95% CI （11.80,2 096.95） and 0.61 with 95% CI （0.46,0.82） respectively. Pooled diagnostic odds ratio was 398.25 （34.5,4 596.81）. The area under summary receiver operating characteristic （SROC） curve was 0.809,and Q index was 0.744. Conclusion Pulse oximetry is a lowly sensitive and highly specific diagnostic method for children with CHD,and is helpful for early diagnosis of CHD.

关 键 词：脉搏血氧仪 先天性心脏病 诊断 系统评价 META分析 

分 类 号：R725.4[医药卫生—儿科]