摘要
目的 用荟萃分析方法评价64层螺旋CT诊断冠心病的价值,比较国内外研究的差异.方法 检索Cochrane图书馆、Medline、OVID数据库以及中国期刊网1998至2009年公开发表的国内外文献,按照纳入标准筛选文献.对纳入的研究进行异质性检验,并选择相应的效应模型对所有研究定量合并,计算汇总敏感度、特异度及其95%可信区间,绘制汇总受试者工作特征 （SROC） 曲线并计算曲线下面积,并且进行国内外研究的对比分析.结果 共检索到文献433篇,排除研究目的或设计不符的文献后,共纳入108篇（国内62篇,国外46篇）.由于无金标准、无盲法、无法计算数据而剔除的国内外文献分别为7篇和20篇（P〉0.05）、44篇和6篇（P〈0.05）、3篇和1篇（P〈0.05）,最终获取文献27篇.国内文献8篇,64层螺旋CT评价血管段的汇总灵敏度、特异度和SROC曲线下面积分别为0.892（95%CI：0.868～0.913）、0.972（95%CI：0.966～0.977）和0.983（95%CI：0.966～1.000）;国外文献19篇,64层螺旋CT评价患者的汇总灵敏度、特异度和SROC曲线下面积分别为0.971（95%CI：0.957～0.982）、0.878（95%CI：0.852～0.902）和0.973（95%CI：0.958～0.989）,评价血管支的汇总灵敏度、特异度和SROC曲线下面积分别为0.917（95%CI：0.895～0.936）、0.919（95%CI：0.909～0.928）和0.974（95%CI：0.964～0.984）;评价血管段的汇总灵敏度、特异度和SROC曲线下面积分别为0.882（95%CI：0.868～0.895）、0.959（95%CI：0.956～0.962）和0.985（95%CI：0.978～0.992）.国内外64层螺旋CT血管段汇总特异度差异有统计学意义（P〈0.05）.结论 荟萃分析表明,64层螺旋CT在诊断冠心病时,有较高的灵敏度和特异度.国外研究的诊断试验设计较国内研究严谨,结果可信度较高.
Objective This meta-analysis evaluated the accuracy of diagnosing coronary artery disease using 64-section spiral computed tomography, and compared the difference between Chinese studies and abroad studies.Methods Relevant English and Chinese articles published from 1998 to 2009 were searched in Cochrane library, Medline, Embase database,OVID database and CNKI. Heterogeneity was tested, pooled weighted sensitivity and specificity and the corresponding 95%CI were calculated. Summary receiver operating characteristic （SROC） curve was drawn and the area under the curve was calculated, differences between studies from China and abroad were compared. Results A total of 433 articles were searched and 108 articles were included（46 English articles and 62 Chinese articles）after excluding articles of research purposes or design does not match.Because of no gold standard, no blind, can not be calculated literature data, 7 and 20 （P〉0.05）, 44 and 6 （P〈0.05）, 3 and 1 （P〈0.05） Chinese studies and English articles respectively were excluded.Twenty-seven articles fulfilled all inclusion criteria （8 Chinese and 19 foreign studies） In 8 Chinese studies the pooled weighted sensitivity and specificity and area under SROC curve was 0.892 （95%CI： 0.868-0.913）, 0.972 （ 95%CI：0.966-0.977） and 0.983 （95%CI：0.966-1.000） at segment-based analysis. In 19 foreign studies, the pooled weighted sensitivity and specificity and area under SROC curve was 0.971（95%CI：0.957-0.982）,0.878（95%CI：0.852-0.902）and 0.973（95%CI：0.958-0.989）at patient-based analysis, 0.917（95%CI：0.895-0.936）, 0.919（95%CI：0.909-0.928） and 0.974（95%CI：0.964-0.984）at vessel-based analysis, 0.882（95%CI：0.868-0.895）,0.959（95%CI：0.956-0.962）and 0.985（95%CI：0.978-0.992）at segment-based analysis. Pooled weighted pecificity of 64-section spiral CT angiography at segment-based analysis has significant different between home and abroad （P〈0.05）.Conclusions Meta-analysis showed that noninvasive 64-section spiral computed tomography could correctly diagnose coronary artery disease with high sensitivity and specificity. Quality of related studies performed in abroad is significantly higher than those performed in China.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2011年第6期553-558,共6页
Chinese Journal of Cardiology
