双源CT对冠状动脉狭窄诊断价值的Meta分析

Dual-source CT in the Diagnosis of Coronary Artery Stenosis: a Meta Analysis

目的对研究双源CT诊断冠状动脉狭窄的文献进行Meta分析,并评估双源CT诊断冠状动脉狭窄的价值,为临床决策提供依据。资料与方法以dual source CT(computed tomography)、conventional coronary angiography、CAG、coronary stenosis、双源CT、冠状动脉造影、冠状动脉狭窄为检索词,检索2006-01～2010-12OVID、cochrane图书馆(2010-3)、Pubmed、Embase、中国学术期刊网全文数据库、中国生物医学文献数据库等相关中英文文献。遵循循征医学方法,对符合纳入及排除标准的原始研究进行异质性检验及质量评估,汇总加权特异性和敏感性,进而汇总受试者工作特征曲线(SROC),通过曲线下面积进一步评价双源CT诊断冠状动脉狭窄的价值,进行敏感性分析。参照循证医学中的证据评价标准,应用QUADAS条目进行文献评价。结果共纳入13篇文献,其中2篇为中文,11篇为英文。在进入异质性检验过程中发现根据纳入标准纳入研究的文献存在异质性,按照随机效应模型加权定量合并,并汇总出加权特异度、灵敏度及相应的95%可信区间(CI)分别为0.96(95%CI0.95～0.96)和0.92(95%CI0.91～0.93),SROC曲线下面积为99.06%。纳入文献稳定性好。结论双源CT冠状动脉造影是一种比较好的针对冠状动脉狭窄的无创性检查方法,具有很好的临床应用价值。

Purpose To study dual-source CT in the diagnosis of coronary artery stenosis with meta-analysis, and to provide information for clinical decision. Materials and Methods Dual-source CT （computed tomography）, conventional coronary angiography, coronary artery stenosis, coronary angiography, CAG, coronary stenosis were selected as the search terms. A search in cochrane library, PubMed, OVID, Embase, China National Knowledge, Infrastructure （CNKI）, China biological medical literature database was performed to identify relevant Chinese and English literatures from January 2006 to December 2010. Following evidence-medical method, the original researches met the inclusion and exclusion criteria were performed heterogeneity test and quality evaluation. The weighted sensitivity and specificity were aggregated, as well as the summary receiver operating characteristic （SROC） curve. Further evaluation of the value of dual-source CT in the diagnosis of coronary artery stenosis was performed by calculating the area under the curve, and the sensitivity analysis was also performed. All articles were evaluated by QUADAS items. Results A total of 13 studies were eligible for meta-analysis, including 2 Chinese articles and 11 English papers. Test of heterogeneity revealed heterogeneity among the literatures included in the study. According to the random effects model, the weighted specificity, sensitivity and corresponding 95% confidence intervals were 0.92 （95% CI 0.91-0.93） and 0.96 （95% CI 0.95-0.96）, respectively, and the area under the SROC curve was 99.06%. This showed that the included studies had good stability. Conclusion Dual-source CT coronary angiography is a good noninvasive method as a routine examination for coronary artery screening, which shows coronary artery stenosis with high sensitivity and specificity, and has a good clinical value.