CT灌注与CT血管成像对蛛网膜下腔出血后脑血管痉挛诊断价值的Meta分析

Meta Analysis on Value of CT Perfusion and CT Angiography Diagnosis of Vasospasm after Onset of Subarachnoid Hemorrhage

目的:采用Meta分析法比较CT脑血流灌注(computer tomography perfusion,CTP)与CT血管造影(computer tomography angiography,CTA)在蛛网膜下腔出血(subarachnoid hemorrhage,SAH)后脑血管痉挛(cerebral vasospasm,CVS)的诊断价值。方法:以Sino Med、中国期刊网、维普数据库等为国内文献的主要来源;Cochrane图书馆、Medline数据库及Ovid数据库、Elsevier和Springer数据库等作为国外文献的主要来源。发表年限为1999年至2014年。按照Cochran协作网推荐的诊断试验纳入标准选取文献,并提取纳入研究的诊断信息。统计分析采用Rev Man 5.0软件,并同时考察纳入文献间的异质性,再根据异质性结果选择相应的效应模型。对所纳入的研究予以加权定量合并,得出合并效应量,计算其95%可信区间,并对合并效应量进行假设检验。结果:按照纳入标准共获取文献6篇,其中有关CTP的3篇(多层螺旋CT),CTA为4篇,均有金标准DSA比较;前瞻性研究2篇,回顾性研究4篇。各组研究均不存在异质性,按照固定效应模型对纳入文献行汇总分析。结果显示,对于蛛网膜出血后脑血管痉挛、CTP诊断的合并效应量估计值为1.59,95%可信区间为0.94-2.69;CTA合并效应量估计值为1.45,95%可信区间为1.18-1.77。结论:对于蛛网膜下腔出血后脑血管痉挛,CTP诊断的准确性高于CTA诊断。

Objective： To assess and compare the overall diagnostic value of CT perfusion（CTP） and CT angiography（CTA） in patients with cerebral vasospasm（CVS） after onset of subarachnoid hemorrhage（SAH）. Methods： Articles in Cochrane library, Medline,Ovid, Elsevier and Springer databases published from 1999 to 2014 were selected to be the relevant English articles; Articles in Chinese Periodical Web, Sino Med, and VIP database were checked for Chinese articles. The criteria for inclusion were established based on validity criteria for diagnostic research published by Cochrane Method Group on Screening and Diagnostic Test. Subsequently, the characteristics of the included articles were appraised and extracted. Statistical analysis was performed employing Rev Man 5.0. Heterogeneity and combined test of the included articles finished, which were used to calculate corresponding 95% confidence interval. Results： Six of the 192 retrieved articles were included. Among them, there were three articles refered to CTP and another four articles refered to CTA.All of the involved articles were compared with digital subtraction angiography（DSA）. Two were prospective study and four were retrospective. There was no heterogeneity in each groups, and a fixed effect regression was developed to analyze the involved articles. The combined test for CTP to vasospasm after SAH was 1.59, 95% confidence interval（CI） was 0.94-2.69; and CTA to vasospasm after SAH was 1.45. 95% CI was 1.18-1.77. Conclusions： With respect to diagnostic accuracy and conclusive result, CTP is more accurate than CTA in diagnosing vasospasm after SAH.