卒中后认知障碍评估工具筛查准确性的Meta分析  

The Accuracy of Screening for Post-stroke Cognitive Impairment Assessment Tools:a Meta-analysis

作　　者：马玉霞[1,2] 杨依依[1] 魏晓琴 陈燕茹 秦江霞 袁月 陈雅婧[1] 吴银瓶 韩琳[1,4] MA Yuxia;YANG Yiyi;WEI Xiaoqin;CHEN Yanru;QIN Jiangxia;YUAN Yue;CHEN Yajing;WU Yinping;HAN Lin(Center for Evidence-based Nursing,School of Nursing,Lanzhou University,Lanzhou 730011,China;The First School of Clinical Medicine,Lanzhou University,Lanzhou 730000,China;Department of Medical Oncology,the Second Hospital of Lanzhou University,Lanzhou 730030,China;Department of Nursing,Gansu Provincial Hospital,Lanzhou 730000,China)

机构地区：[1]兰州大学护理学院循证护理中心,甘肃省兰州市730011 [2]兰州大学第一临床医学院,甘肃省兰州市730000 [3]兰州大学第二医院肿瘤内科,甘肃省兰州市730000 [4]甘肃省人民医院护理部,甘肃省兰州市730000

出　　处：《中国全科医学》2024年第32期4066-4076,共11页Chinese General Practice

基　　金：国家自然科学基金资助项目(72274087);甘肃省自然科学基金资助项目(22JR5RA218);甘肃省重点研发计划(23YFFA0006);中华医学会基金(20-374);兰州大学护理学院科研基金(LZUSON202002);兰州市城关区科技局项目(2022SHFZ0002);兰州市卫生科技项目(2021003)。

摘　　要：背景卒中后认知障碍(PSCI)给患者及其家庭带来沉重的负担,早期识别及干预有助于延缓PSCI的发生及进展,因此,使用准确的神经心理评估工具对PSCI进行筛查,对于患者的管理和治疗至关重要。目的采用Meta分析的方法评价PSCI筛查工具的筛查准确性,为准确筛查PSCI提供依据。方法检索数据库中国知网、维普网、万方数据知识服务平台、中国生物医学文献服务系统、PubMed、Embase、Web of Science、Cochrane Library中有关PSCI筛查工具的诊断性试验研究,检索日期为建库至2022年12月。2位研究者各自筛选文献、提取数据、评估偏倚风险。采用Stata 17.0软件分析数据。结果共纳入57篇文献,包含12113例患者,报告了7种PSCI筛查工具:美国国立神经疾病和卒中研究院-加拿大卒中网5-min测验(NINDS-CSN 5-min测验)、蒙特利尔认知评估量表(MoCA)、简易精神状况检查量表(MMSE)、老年认知功能减退知情者问卷(IQCODE)、阿登布鲁克认知能力检查-修订版(ACE-R)、认知功能电话问卷修订版(TICS-m)、5分钟蒙特利尔评估(MoCA-5 min)。Meta分析结果显示:MoCA筛查PSCI的合并灵敏度及特异度分别为0.84(95%CI=0.80~0.87)和0.74(95%CI=0.67~0.80),合并AUC为0.87(95%CI=0.84~0.90);MMSE筛查PSCI的合并灵敏度及特异度为0.73(95%CI=0.67~0.79)和0.76(95%CI=0.69~0.82),合并AUC为0.81(95%CI=0.77~0.84);IQCODE筛查PSCI的合并灵敏度及特异度为0.73(95%CI=0.48~0.89)和0.95(95%CI=0.75~0.99),合并AUC为0.91(95%CI=0.88~0.93);NINDS-CSN 5-min测验筛查PSCI的合并灵敏度及特异度为0.83(95%CI=0.78~0.87)、0.69(95%CI=0.60~0.76),合并AUC为0.85(95%CI=0.81~0.88);ACE-R筛查PSCI的合并灵敏度及特异度为0.90(95%CI=0.80~0.95)、0.61(95%CI=0.19~0.91),合并AUC为0.90(95%CI=0.87~0.92);TICS-m筛查PSCI的合并灵敏度及特异度为0.84(95%CI=0.75~0.91)、0.67(95%CI=0.61~0.74),合并AUC为0.66(95%CI=0.60~0.71)。结论IQCODE和ACE-R的合并AUC较高,且IQCODE具有较高的合并特�Background Post-stroke cognitive impairment(PSCI)brings a heavy burden to patients and their families.An early recognition and intervention can help delay the occurrence and development of PSCI.Therefore,the use of accurate neuropsychological assessment tools to screen for PSCI is essential for the management and treatment of PSCI.Objective To analyze the screening accuracy of assessment tools for PSCI by meta-analysis,thus providing references for an accurate screening of PSCI.Methods Diagnostic trials on screening tools of PSCI published from the establishment of the database to December 2022 were searched in CNKI,VIP,Wanfang Data,SinoMed,PubMed,Embase,Web of Science,Cochrane Library.Two researchers respectively screened literatures,extracted data,and assessed the risk of bias.Stata 17.0 software was used to analyze the data.Results A total of 57 articles were included,involving 7 assessment tools[the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network 5-Minute Battery(NINDS-CSN 5-Minutes),the Montreal Cognitive Assessment(MoCA),the Mini-Mental State Examination(MMSE),the Informant Questionnaire on Cognitive Decline in the Elderly(IQCODE),the Addenbrooke's Cognitive Examination-Revised(ACE-R),the Telephone Interview for Cognitive Status Modified(TICS-m)and the Montreal Cognitive Assessment 5-minute protocol(MoCA-5 min)]to screen 12113 patients.Meta-analysis results showed that the combined sensitivity and specificity of MoCA in screening PSCI were 0.84(95%CI=0.80-0.87)and 0.74(95%CI=0.67-0.80),respectively,with a combined area under the curve(AUC)of 0.87(95%CI=0.84-0.90).The combined sensitivity and specificity of MMSE in screening PSCI were 0.73(95%CI=0.67-0.79)and 0.76(95%CI=0.69-0.82),respectively,with a combined AUC of 0.81(95%CI=0.77-0.84).The combined sensitivity and specificity of IQCODE in screening PSCI were 0.73(95%CI=0.48-0.89)and 0.95(95%CI=0.75-0.99),respectively,with a combined AUC of 0.91(95%CI=0.88-0.93).The combined sensitivity and specificity of the NINDS-CSN 5-min

关 键 词：卒中后认知障碍 筛查工具 META分析 诊断性试验 

分 类 号：R749.1[医药卫生—神经病学与精神病学]