全身运动质量评估对高危新生儿神经发育结局预测价值的Meta分析

Predictive Value of Qualitative General Movement Assessment for Neurodevelopmental Outcome in High Risk Neonates: A Meta-analysis

目的:系统评价全身运动质量评估(GMs)对高危新生儿神经系统发育异常的预测价值。方法:计算机检索PubMed、Cochrane Library(2016年第3期)、Embase、CNKI、CBM、VIP及Wan Fang数据库中相关的诊断准确性试验,截止日期为2016年4月28日。由2位研究者独立筛选文献、提取数据和评价纳入研究的方法学质量后,采用Meta-Disc 1.4软件进行Meta分析。结果:共纳入11例诊断准确性试验,合计1 308例高危新生儿。Meta分析结果显示:GMS预测神经系统发育异常的敏感度、特异度、阳性似然比、阴性似然比、诊断优势比分别为0.88[95%CI(0.83,0.91)]、0.93[95%CI(0. 91,0. 95)]、8. 76[5%CI(5. 00,15. 32)]、0. 17[95%CI(0. 11,0. 26)]、77. 81[95%CI(33. 71,179.62)],受试者工作特征(SROC)曲线下面积(AUC)为0.9509。GMS预测脑瘫的敏感度、特异度、阳性似然比、阴性似然比、诊断优势比分别为0.91[95%CI(0.85,0.95)]、0.95[95%CI(0.93,0.96)]、10.16[95%CI(5.32,19. 41)]、0.16[95%CI(0.10,0.25)]、155.03[95%CI(67.56,355.70)],SROC曲线下面积0.9705。结论:GMs对高危新生儿神经系统发育异常具有较高预测价值,对脑瘫的预测价值更高。

Objective To systematically review the predictive value of qualitative general movements (GMs)assessment for neurological dysplasia in high risk neonates.Methods The relevant diagnostic accuracy tests were performed using PubMed,Cochrane Library (Issue 3,2016),EMbase,CNKI,CBM,VIP and WanFang databases,with a deadline of April 28,2016.Two researchers independently screened literature,extracted data and evaluated the methodological quality of the study.Meta analysis was performed using Meta-Disc 1.4software.:Results :A total of 11 studies involving 1308 high risk neonates were finally included.The results of meta-analysis showed that the sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and diagnostic advantage ratio of GMS in predicting neurodevelopmental abnormalities were 0.88[95%CI(0.83,0.91)3,0.93[95%CI(0.91,0.95)3,8.76[95%CI(5.00,15.32)],0.17[95%CI(0.11,0. 26)],and 77.81 [95%CI (33.71,-179.62)].The area under the SROC curve (AUC)was 0.9509.The sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and diagnostic advantage ratio of GMS in predicting cerebral palsy were 0.91 [95%CI(0.85,0.95)],0.95[95%CI(0.93,0.96)3,10.16[95%CI(5.32,19.41)],0.16[95%CI(0.10, 0.25)],and 155.03[95%CI(67.56,355.70)]respectively.The area under SROC curve is 0.9705,the AUC of SROC was 0.9705.Conclusion GMs have high predictive value for neurological dysplasia in high-risk neonates and have a higher predictive value for cerebral palsy.