数字射线胸片与高仟伏胸片对尘肺病诊断结果的meta分析

Meta analysis on digital radiography and high-kV X-ray chest radiography in pneumoconiosis diagnosis

目的回顾数字射线(DR)胸片与高仟伏(Hk V)胸片对尘肺病诊断结果的文献报道,为DR胸片应用于尘肺病诊断提供科学依据。方法通过计算机检索万方、CNKI、PUBMED数据库2009—2014年有关运用DR胸片与Hk V胸片诊断尘肺病的15篇研究文献,应用meta分析对符合纳入标准的文献进行异质性检验以及合并比值比(OR合并)和95%可信区间(95%CI)的计算。采用随机效应模型分析DR胸片和Hk V胸片检查的尘肺病分期诊断结果;采用固定效应模型分析DR胸片与Hk V胸片小阴影密集度的检出。结果尘肺病各期的OR合并(95%CI)分别为:无尘肺0.98(0.79,1.21)、壹期尘肺0.97(0.77,1.22)、贰期尘肺1.21(1.01,1.45)和叁期尘肺0.90(0.67,1.19),除贰期尘肺DR胸片的敏感度略好于Hk V胸片(P<0.05)外,其他分期差异均无统计学意义。运用DR胸片与Hk V胸片判断小阴影总体密集度的meta分析结果显示,各级的OR合并(95%CI)分别为:0级0.98(0.79,1.21)、1级1.06(0.85,1.32)、2级0.96(0.71,1.28)和3级0.88(0.56,1.38),两者差异无统计学意义。结论 DR胸片可以代替Hk V胸片用作尘肺病诊断和筛查。

[Objective]Reviewed the past literatures to provide a scientific basis for the application of digital radiography（DR）in pneumoconiosis diagnosis by comparing with high-k V X-ray（Hk V） chest radiography.[Methods]Through retrieval of Wangfang,CNKI,PUBMED,a total of 15 studies of DR and Hk V chest radiography in pneumoconiosis diagnosis from 2009-2014 was found. Meta analysis was used to test the heterogeneity and combined odds ratio（ORcombined）and 95% confidence interval（95%CI）. Random effects model was used to analyze the DR and Hk V chest radiography for pneumoconiosis stages; fixed effects model was used to analyze the DR and Hk V chest radiography for the overall intensity of small opacity. [Results]The ORcombined（95% CI）of the DR and Hk V chest radiography for pneumoconiosis stages was no pneumoconiosis of 0.98（0.79,1.21）,stage I pneumoconiosis of 0.97（0.77,1.22）,stage II pneumoconiosis of 1.21（1.01,1.45） and stage III pneumoconiosis of 0.90（0.67,1.19）. The results showed that DR chest radiography have a little advantage over Hk Vin stage II pneumoconiosis,no significant difference was observed between other stage. The meta analysis of the DR and Hk V chest radiography in identifying the overall intensity of small opacity showed OR combined（95% CI）of each stage was 0 level of 0.98（0.79,1.21）,1 level of1.06（0.85,1.32）,2 level of 0.96（0.71,1.28）and 3 level of 0.88（0.56,1.38）,without significance. [Conclusion]DR can replace Hk V chest radiography used for pneumoconiosis diagnosis and screening.