DESH征对iNPH手术预后诊断价值的Meta分析  

Diagnostic value of DESH for shunt responsiveness in idiopathic normal pressure hydrocephalus:A meta-analysis

作　　者：杨琼[1] 刘春艳[1] 滑蓉蓉 魏友平 邢岩[1] YANG Qiong;LIU Chunyan;HUA Rongrong;WEI Youping;XING Yan(Department of Neurology,Aviation General Hospital,China Medical University,Beijing 100012,China)

机构地区：[1]中国医科大学航空总医院神经内科,北京100012

出　　处：《磁共振成像》2020年第8期625-629,共5页Chinese Journal of Magnetic Resonance Imaging

基　　金：北京市自然科学基金项目(编号:7202237);航空总医院重点疾病研究室科研项目(编号:YJ202001)。

摘　　要：目的系统评价蛛网膜下腔不成比例扩大的脑积水(disproportionately enlarged subarachnoid space hydrocephalus,DESH)征对特发性正常压力脑积水(idiopathic normal pressure hydrocephalus,iNPH)手术预后的诊断价值。材料与方法计算机检索WanFang Data、CNKI、PubMed、The Cochrane Library、Web of Science和EMbase数据库,搜集DESH征诊断iNPH手术预后的诊断性试验,文献检索时限均从建库至2020年5月。由两名研究者按照纳入与排除标准进行独立筛选文献、提取资料并采用QUADAS-2工具评价纳入研究的偏倚风险后,使用Meta-Disc 1.4软件进行Meta分析。结果共纳入5个研究,包括333例患者。Meta分析结果显示:DESH征诊断iNPH的合并敏感度、特异度、阳性似然比、阴性似然比、诊断比值比和绘制汇总受试者工作特征(summary receiver operating characteristics,SROC)曲线并计算曲线下面积分别为60%[95%CI(0.54,0.67)]、66%[95%CI(0.56,0.76)],1.87[95%CI(1.13,3.10)]、0.45[95%CI(0.23,0.88)]、4.91[95%CI(1.45,16.68)]和0.75。结论本研究系统评价DESH征对iNPH手术预后的诊断价值,尽管其仅具有中等诊断价值,但仍有比较重要的临床意义,因纳入研究较少,仍需开展更多研究予以证实,同时提醒临床工作者应重视影像学尤其是核磁共振检查在iNPH诊断中的意义。Objective:To systematically review the predictive value of disproportionately enlarged subarachnoid space hydrocephalus(DESH)in the shunt responsiveness in idiopathic normal pressure hydrocephalus(iNPH).Materials and Methods:WanFang Data,CNKI,PubMed,the Cochrane Library,Web of Science,and Embase databases were electronically searched to collect studies on the predictive value of DESH in the shunt responsiveness in iNPH from inception to May 2020.Two reviewers screened literature,extracted data and assessed the risk of bias of included studies by QUADAS-2 standard independently according to inclusion and exclusion criteria.Meta-Disc 1.4 software was used to performed Metaanalysis.Results:A total of 5 studies involving 333 patients were included.The results of our study showed that the pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnosis odds ratio and area under the curve of summary receiver operating characteristics were 60%[95%CI(0.54,0.67)],66%[95%CI(0.56,0.76)],1.87[95%CI(1.13,3.10)],0.45[95%CI(0.23,0.88)],4.91[95%CI(1.45,16.68)]and 0.75.Conclusions:This study to systematically evaluate the diagnostic value of DESH sign on the prognosis of iNPH shunt surgery at home and abroad.Although DESH sign has only moderate diagnostic value,it still has relatively important clinical significance.Due to the limited quality and quantity of included studies,the results of meta-analysis should be validated by more studies.It also needs to pay attention to the significance of imaging especially MRI in the diagnosis of iNPH.

关 键 词：DESH征 特发性正常压力脑积水 分流手术 诊断价值 META分析 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R742.7[医药卫生—诊断学]