腰椎间盘MRI高信号区与椎间盘造影阳性相关性的Meta分析

The correlation between HIZ on MRI T2-weighted and positive outcome of discography: a Meta-analysis

目的：系统评价腰椎间盘MRI高信号区（HIZ）与椎间盘造影阳性的相关性。方法：计算机检索1973年1月-2013年4月MEDLINE、EMBASE、CochraneCENTRAL（First Quarter 2013）、ScienceDirect、OVID、Springer—Link、中国生物医学文献数据库。纳入文献为腰痛患者接受腰椎MRI和椎间盘造影检查、并对MRI所观察到的HIZ与椎间盘造影检查椎间盘形态学变化和疼痛复制现象进行相关性比较的临床观察性研究．筛选出符合纳入标准的文献，评价纳入研究的方法学质量。利用RevMan5．1．1（下载于CochraneLibrary）对提取数据进行Meta分析。结果：经过筛选，11篇文献符合纳入标准。Meta分析结果显示：HIZ阳性与椎间盘造影中椎间盘形态不正常存在显著相关性，有统计学意义[OR=47．79，95％CI（17．07，133．77），P〈0．00001]；HIZ阳性的椎间盘在造影中产生一致性疼痛的发生率（79％，309／393）高，与HIZ阴性（29％，237／805）比较有统计学差异[OR=8．65，95％CI（4．92，15.23），P〈0．00001]；HIZ阳性且椎间盘形态异常的节段产生一致性疼痛的发生率高（90％，211／235），与HIZ阴性（34％，87／257）比较有统计学差异[OR=8．65，95％CI（4．92，15．23），P=0．007]。结论：腰椎间盘MRIHIZ的出现预示着椎间盘形态的异常．HIZ阳性与椎间盘造影疼痛复制之间存在明显的相关性，HIZ可作为临床责任间隙判断及椎间盘源性腰痛诊断的一个有效指标．

Objectives： To assess the correlation between high intensity zone （HIZ） of lumbar MRI and discography. Methods： A computer-based online search of Medline, EMBASE, Cochrane CENTRAL （lst Quarter 2013）, ScienceDirect, OVID, SpringerLink and The China Biological Medicine Database（from January 1973 to April 2013）. The included trials were lumbar pain patient undergoing discography and MRI, and the correlation between HIZ and discography positive was observed. The literature was screened out according to the included standard. The quality of included trials was evaluated. RevMan 5.1.1 was used for data analysis. Results： Eleven studies were included. The results of Meta-analysis indicated that outstanding relativity and statistically significant difference were observed between HIZ and abnormal morphology of disc [OR=47.79, 95%CI（17.07, 133.77）, P〈0.00001], HIZ and pain reproduction[OR=8.65, 95%CI（4.92, 15.23）,P〈0.00001], HIZ and abnormal morphology pain reproduction[OR=8.65, 95%CI（4.92, 15.23）, P=0.007]. Conclusions： The oceurence of HIZ on lumbar MRI T2-weighted image indicates abnormal morphology of the disc. There is obvious relationship between HIZ and pain reproduction. HIZ can be a very effective index to determine responsible level discogenic low back pain.