^(123)I-MIBG及^(123)I-FP-CIT SPECT/CT显像鉴别诊断帕金森病与非典型帕金森综合征:Meta分析  

^(123)I-MIBG and ^(123)I-FP-CIT SPECT/CT for differential diagnosis of Parkinson disease and atypical Parkinson syndrome:Meta-analysis

作　　者：左睿 王政杰[1] 翁宇 刘双 许璐[1] ZUO Rui;WANG Zhengjie;WENG Yu;LIU Shuang;XU Lu(Department of Nuclear Medicine,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院核医学科,重庆400016

出　　处：《中国医学影像技术》2022年第3期346-352,共7页Chinese Journal of Medical Imaging Technology

摘　　要：目的采用Meta分析评价^(123)I-间碘苄胍(^(123)I-MIBG)及N-氟丙基-2b-甲酯基-3b-(4-^(123)I-碘苯基)降托烷(^(123)I-FP-CIT)SPECT/CT显像鉴别诊断帕金森病(PD)与非典型帕金森综合征(APS)的价值。方法检索PubMed、EMbase、Ovid EBMR、Cochrane Library及中国知网、万方医学网、维普数据库中2000年1月—2020年10月有关^(123)I-MIBG及^(123)I-FP-CIT SPECT/CT显像鉴别PD与APS的文献。筛选文献后,根据显像结果将^(123)I-MIBG SPECT/CT分为早期及延迟显像,评价其鉴别PD与APS的效能;采用Stata 16.0和Metadisc 1.4软件行Meta分析。结果共纳入20篇文献,包括1106例PD及365例APS患者。^(123)I-MIBG显像鉴别诊断PD与APS无明显阈值效应(r=0.58,P<0.05),而^(123)I-FP-CIT存在阈值效应引起的异质性(r=0.89,P<0.01);二者鉴别诊断PD与APS均存在非阈值效应引起的中高度异质性(I^(2)均>50%);^(123)I-MIBG早期及延迟显像鉴别诊断PD与APS均有较高异质性(I^(2)均>50%),故均以双变量混合效应模型分析数据。^(123)I-MIBG及^(123)I-FP-CIT SPECT/CT显像鉴别诊断PD与APS的合并敏感度分别为0.82[95%CI(0.76,0.86)]及0.90[95%CI(0.84,0.94)],合并特异度分别为0.84[95%CI(0.68,0.93)]及0.27[95%CI(0.12,0.50)],综合受试者工作特征(SROC)显示其AUC分别为0.87及0.81;^(123)I-MIBG SPECT/CT早期及延迟显像鉴别诊断PD与APS的合并敏感度分别为0.74[95%CI(0.63,0.82)]及0.82[95%CI(0.77,0.87)],合并特异度分别为0.94[95%CI(0.78,0.98)]及0.79[95%CI(0.61,0.90)],SROC的AUC均为0.86。结论^(123)I-MIBG及^(123)I-FP-CIT SPECT/CT显像可互为补充用于鉴别诊断PD与APS;^(123)I-MIBG早期及延迟显像的鉴别效能均较高。Objective To observe the value of ^(123)I-metaiodobenzylguanidine(^(123)I-MIBG)and N-vfluoro-propyl-2b-carbomethoxy-3b-(4-^(123)I-iodophenyl)nortropane(^(123)I-FP-CIT)SPECT/CT imaging for differential diagnosis of Parkinson disease(PD)and atypical Parkinson syndrome(APS)with meta-analysis.Methods Literature concerning differential diagnosis of PD and APS with ^(123)I-MIBG and ^(123)I-FP-CIT imaging were searched in the PubMed,EMbase,Cochrane Library,Ovid EBMR,CNKI,Wanfang Med Online and VIP databases from January 2000 to October 2020.According to imaging results,^(123)I-MIBG SPECT/CT was divided into early imaging and delayed imaging,and the efficacies of differentiating PD from APS were evaluated.Stata 16.0 and Metadisc 1.4 software were used for meta-analysis of the literature.Results Twenty articles were enrolled,including 1106 PD and 365 APS patients.There was no significant threshold effect in differential diagnosis of PD and APS with ^(123)I-MIBG imaging(r=0.58,P<0.05),but there was heterogeneity caused by threshold effect in ^(123)I-FP-CIT imaging(r=0.89,P<0.01).There were middle and high heterogeneous caused by non-threshold effect(all I^(2)>50%).The early and delayed ^(123)I-MIBG imaging had high heterogeneity in differential diagnosis of PD and APS(all I^(2)>50%),thus bivariate mixed-effects model was used to analyze the data.The pooled sensitivity and specificity of ^(123)I-MIBG and ^(123)I-FP-CIT SPECT/CT imaging in differential diagnosis of PD and APS was 0.82(95%CI[0.76,0.86])and 0.90(95%CI[0.84,0.94]),0.84(95%CI[0.68,0.93])and 0.27(95%CI[0.12,0.50]),respectively,and the area under curve(AUC)of summary receiver operating characteristic(SROC)was 0.87 and 0.81,respectively.The pooled sensitivity and specificity of early and delayed ^(123)I-MIBG SPECT/CT imaging in differential diagnosis of PD and APS was 0.74(95%CI[0.63,0.82])and 0.82(95%CI[0.77,0.87]),0.94(95%CI[0.78,0.98])and 0.79(95%CI[0.61,0.90]),and the AUC of SROC was both 0.86.Conclusion Both ^(123)I-MIBG and ^(123)I-FP-CIT SPECT/CT imaging had

关 键 词：帕金森病 非典型帕金森综合征 体层摄影术 发射型计算机 单光子 荟萃分析 

分 类 号：R742.5[医药卫生—神经病学与精神病学] R817.4[医药卫生—临床医学]