椎间盘突出症CT椎间盘造影诊断的荟萃分析

The diagnostic accuracy of CT/Discography for intervertebral disc herniation:a Meta-analysis

目的用荟萃(Meta)分析评价CT椎间盘造影(CTD)对椎间盘突出症的诊断价值。方法检索Pubmed、OVID、EBSCO外文数据库、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)和万方数据库中的相关文献,结合Cochrane协作网推荐内容制定纳入标准筛选文献,提取纳入研究的特征信息并采用2011年版QUADAS/STARD评价系统对纳入文献进行质量评估,绘制Deeks漏斗图检验发表偏倚。采用Bivariate模型进行数据分析、合并:进行异质性检验,亚组分析讨论异质性来源;合并得到阳性似然比、阴性似然比、诊断比值比、汇总灵敏度、特异度及95%可信区间,绘制灵敏度特异度的森林图;绘制汇总受试者工作特性曲线(SROC)并计算曲线下面积(AUC)。结果纳入文献8篇,共含病例533例(999个椎间盘);合并灵敏度、特异度及95%可信区间分别为0.901(0.773～0.960)、0.848(0.744～0.915)。AUC及95%可信区间为0.93(0.91～0.95)。结论对于椎间盘突出症的诊断,CTD具有较高的灵敏度、特异度和准确率,可作为椎间盘突出症重要的临床诊断方法之一。

Objective To assess the value of CT Discography(CTD)in diagnosis of intervertebral disc herniation with Meta analysis.Methods A search in PubMed,OVID,EBSCO,CNKI,CBM and WAN FANG was performed to identify relevant English and Chinese language articles,respectively.Criteria for inclusion were established based on validity criteria for diagnostic research published by the Cochrane Methods Group on Screening and Diagnostic.The sensitivity,specificity,summary receiver operating characteristic(SROC)curves,area under the curve(AUC)and the heterogeneity were calculated with bivariate model.Results Eight of 3420 retrieved articles were included,with a total of 533 patients(999 disks).The pooled weighted sensitivity and specificity for CTD with 95% confidence interval(95% CI)after correction for standard error were 0.901(0.773-0.960)and 0.848(0.744-0.915),respectively.The AUC of SROC with 95% CI was 0.93(0.91-0.95).Conclusions CTD which has high sensitivity and specificity in patients for intervertebral disc herniation can be proposed as an important diagnostic method.