CT和MR血管成像诊断急性肺栓塞的Meta分析

Diagnostic value of CT angiography and MR angiography for acute pulmonary embolism based on Meta-analysis

目的：应用 Meta 分析法，以 DSA 为金标准，探讨 CT 肺动脉成像（CTPA）和磁共振肺血管成像（MRPA）对肺动脉栓塞（PE）的诊断价值。方法：检索 Cochrane 图书馆、Medline 数据库、Springerlink 数据库及 Ovid 循证医学数据库中1994～2013年发表的英文文献以及知网数据库和万方医学数据库中1994～2013年发表的中文文献，按照 Cochrane 协作网推荐的诊断性实验的纳入标准，严格筛选与“CTPA 和／或 MRPA 诊断急性 PE”相关的文献。在符合条件的文献中提取诊断信息（包括真阳性值、假阳性值、真阴性值、假阴性值）和其它相关数据。采用 Stata 12软件和 Meta-disc 1．4软件对纳入文献行统计学处理，包括异质性检验，计算敏感度和特异度及其95％可信区间，选择相应的效应模型予以加权定量合并，绘制汇总的工作特征曲线（SROC），最后进行敏感性分析。结果：按照纳入标准共获取有效文献17篇，其中与 CTPA相关的文献10篇，与 MRPA 相关的文献7篇。17篇文献均满足诊断性研究质量评价工具（QUADAS）中提出的14项标准中的10项以上。CTPA 及 MRPA 两组中的相关研究均有异质性，按照随机效应模型对纳入文献进行汇总分析。结果显示，CTPA 诊断肺栓塞的敏感度、特异度及各自的95％可信区间分别为0．78（0．74～0．82）和0．90（0．87～0．92），MR-PA 为0．86（0．79～0．92）和0．97（0．94～0．99），SROC 下面积分别为94％和98％。结论：CTPA 和 MRPA 对急性肺栓塞的诊断均具有很高的价值，两种方法的诊断特异度均很高，作为诊断肺栓塞的无创性检查方法可基本替代 DSA 检查。

Objectire：To investigate the value of CT pulmonary angiography （CTPA）and MR pulmonary angiogra-phy （CTPA）in diagnosis of pulmonary embolism （PE）by Meta-analysis with DSA as the gold standard.Methods：English and Chinese articles published from 1994 to 2013 with＆quot;CTPA and/or MRPA for diagnosis of PE＆quot;as main research content were searched in Cochrane Library,PubMed,Springerlink and OVID database and Chinese periodical Web （CNKI and Wan-fang Database）.According to the criteria for screening and diagnostic tests recommended by Corchrane Method Group,all articles were critically evaluated and selected.The diagnostic data and relevant information in each included article were ex-tracted and summarized for analysis and calculation,including the absolute numbers of true positive,false positive,false negative and true negative.Statistical analysis was performed by using Stata 12 and Meta-disc version 1.4.CTPA and MR-PA heterogeneity and corresponding 95% confidence interval （CI）were calculated.Receiver characteristic curve was ob-tained,and the area under curve was calculated.Finally,sensitivity analysis was performed.Results：17 studies were in ac-cordance with the inclusion criteria,of which 10 papers were related to CTPA and 7 papers were related to MRA.All arti-cles met the diagnostic research quality assessment tool （QUADAS）for more than 10 of 14 items.By using the random effects model,heterogeneity of research was showed between CTPA and MRPA group.The overall sensitivity and specifici-ty with its 95% CI for CTPA in the diagnosis of PE was 0.78 （0.74 ～0.82）and 0.90 （0.87 ～0.92）respectively,with 0.86 （0.79～0.92）and 0.97 （0.94 ～0.99）for MRPA,the AUC of SROC was 94% and 98% respectively.Conclusion：Both CTPA and MRPA are very useful for the diagnosis of acute PE with high specificity,and can be alternatives to DSA as non-invasive and effective imaging methods for the diagnosis of pulmonary embolism.