利用^(99m)Tc-MIBI心肌灌注断层显像诊断冠心病的Meta分析

Diagnosis accuracy of ^(99m)Tc-MIBI myocardial perfusion tomography for detection of coronary heart disease:An evidence-based meta analysis

目的:评价99mTc-MIBI心肌灌注断层显像诊断冠心病的临床价值.方法:检索Cochrane图书馆、Medline数据库、Ovid循证医学数据库及中国期刊网1989/2006年公开发表的中英文文献,按照Cochrane协作网推荐的诊断试验的纳入标准筛选文献;采用Meta分析软件对纳入文献汇总分析,获得汇总灵敏度和特异度及其95%可信区间,并绘制受试者工作特征曲线(SROC)和森林图,最后进行敏感性分析.结果:按照纳入标准共获取文献21篇.99mTc-MIBI心肌灌注显像诊断冠心病的汇总灵敏度、特异度及其95%可信区间分别为0.90(0.86～0.93),0.79(0.69～0.87),SROC曲线下面积为93.78%.运动/静息实验组、潘生丁负荷/静息实验组、多巴酚丁胺负荷/静息实验组的灵敏度/特异度分别为0.87(0.84～0.90)/0.77(0.71～0.83),0.92(0.87～0.95)/0.52(0.43～0.62),0.87(0.82～0.91)/0.81(0.71～0.88),SROC曲线下面积分别为94.87%,93.82%,94.25%.结论:作为一种无创性检查方法,99mTc-MIBI心肌灌注断层显像诊断冠心病具有较高的灵敏度、特异度和准确性,与冠状动脉造影结果具有良好一致性.

AIM： To determine the diagnostic value of technetium-99m methoxyisobutylisonitrile（99mTc-MIBI） myocardial perfusion tomography in detecting coronary heart disease （CHD）. METHODS： Based on validity criteria for diagnostic research published by the Cochrane Methods Group on Screening and Diagnostic, studies from 1989 to 1996 were selected from Cochrane library, medline, Ovid and China National Knowledge Infrastructure. The characteristics of the included articles were appraised and extracted. Statistical analysis was performed by employing Meta-Test 0.6. Heterogeneity of the included articles was tested, which was used to select proper effect model to calculate pooled weighted values of sensitivity and specificity and the corresponding 95% CI. Summary receiver operating characteristic （SROC） curve was performed and the area under the curve （AUC） was calculated. Finally, a sensitivity analysis was performed. RESULTS： Twenty-one articles met inclusion criteria. The pooled sensitivity, specificity and AUC of 99mTc-MIBI tomography in diagnosing CHD were 0.90（95% CI 0.86-0.93 ）, 0.79 （95% CI 0. 694）. 87） and 93.78% respectively. The pooled sensitivity/ specificity of exercise test, dipyridamole test and dobutamine test were 0.87 （ 95% CI 0.84-0.90 ）//0.77 （ 95% CI 0.71-0.83 ）, 0.92（95% CI 0.87-0.95 ）/0.52（95% CI 0.43-0.62） and 0.87 （95% CI0.82-0.91）/0.81（95% CI0.71-0.88）. AUC of the3 groups were 94. 87%, 93. 82% and 94. 25% respectively. CONCLUSION： As a noninvasive method, 99mTc-MIBI myocar-dial perfusion tomography has a better value in detecting CHD, which is in agreement with CAG.