超声检查在肺动脉高压诊疗中可靠性的Meta-分析

Reliability of doppler echocardiographic techniques in detecting and quantifying pulmonary artery hypertension: meta-analysis

目的:综合评价超声检查在肺动脉高压(PAH)诊疗过程中的可靠性。方法:在数据库PubMed(1966年1月至2006年5月),Embase(1980年至2006年),中国期刊网(1978年1月至2006年5月)中,检索以PAH为研究对象,应用超声检查和右心导管检查,评价患者的血流动力学状态,对二种方法所测得的肺动脉收缩压进行比较的临床研究,对超声检查在PAH诊疗过程中的可靠性进行Meta-分析。结果:1.共有8项研究进行了超声检查结果与右心导管检查结果相关性分析,入选PAH患者256例。二者具有良好的相关性,合并后的R值为0.679,95%可信区间为0.623～0.735。2.共有6项研究对超声检查和右心导管检查进行了肺动脉收缩压测量值的比较,超声检查的结果明显低估了右心导管的结果;对其中48h内完成二种检查的2项研究进行综合比较,发现超声检查的结果仍低于右心导管检查结果,但二者差异的显著性降低。结论:在PAH的诊疗过程中超声检查的结果低估了肺动脉收缩压但可以反映其变化趋势。

Objective： To pool the data of studies about echocardiographic techniques in detecting and quantifying pulmonary artery hypertension （PAH） and evaluate its reliability in PAH. Method： A search in PubMed （from January 1st, 1968 to May lst, 2006）, Embase （from 1980 to 2006）, and China National Knowledge Infrastructure （CNKI）（from January 1st, 1978 to May 1st, 2006） was performed to identify relevant English and Chinese articles respectively. Clinical Trials assessed pulmonary hypertension both in right heart catheterization and echocardiography were included to evaluate the reliability of echocardiography in a method of Meat-analysis. Result： 1. Eight studies including 256 PAH patients were chosen to evaluate the correlation of pulmonary artery pressure detected by echocardiography and right heart catheterization. Doppler-derived systolic PAP values were strongly correlated with pressure measured with catheterization, their co-efficiency is 0. 679 （95 % confidence interval, 0. 623- 0.735）. 2. Six studies including 162 PAH patients were chosen to evaluate whether echocardiography estimated the systolic PAP exactly and found that Doppler-derived systolic PAP underestimated systolic PAP, even in the two studies whose systolic PAP were detected using these two methods only in an interval of 48 hours, the Doppler-derived systolic PAP still underestimated the systolic PAP. Conclusion： Pressure detected by Doppler echocardiography under estimates systolic PAP, but is reliable in reflecting the change of pulmonary artery pressure of patients with PAH.