CT血管成像诊断肾动脉狭窄的Meta分析

Meta analysis on CT angiography in diagnosing renal artery stenosis

目的通过Meta分析方法评价CT血管成像（CTA）对肾动脉狭窄（RAS）的诊断价值。方法检索Pubmed、EBSCO、Springer、Ovid和中国期刊网（CNKI）及Cochrane图书馆数据库,文献检索起止时间均从建库至2013年12月,纳入以数字减影血管造影术（DSA）结果为金标准的关于CTA诊断RAS的文献。按照Cochrane协作网推荐的诊断性试验纳入标准筛选文献,对纳入文献进行质量评价,提取各纳入文献的详细资料。采用Meta Disc 1.4软件进行异质性检验及汇总灵敏度、特异度、阳性似然比、阴性似然比、诊断优势比,绘制汇总受试者工作特征曲线（SROC）及计算曲线下面积（AUC）,并进行敏感性分析。结果纳入文献9篇,各研究间无阈值效应,无明显异质性,采用固定效应模型汇总分析,汇总灵敏度、特异度、阳性似然比、阴性似然比、诊断优势比及其95%可信区间分别为0.975（95%CI：0.956-0.987）、0.945（95%CI：0.923-0.962）、12.656（95%CI：9.116-17.573）、0.040（95%CI：0.024-0.067）、412.23（95%CI：204.65-830.38）。AUC=0.987,Q指数=0.951。敏感性分析示纳入文献的稳定性良好。结论 CTA是一种切实可行的无创影像检查方法,对于诊断不同程度RAS患者拥有较高的敏感度及特异度,但是对待CTA诊断轻度及重度狭窄结果应慎重对待,尤其是轻度狭窄者。

Objective To systematically assess the diagnostic value of computed tomography angiography（CTA）for renal artery stenosis（RAS）by using the meta analysis.Methods The literatures about the CT angiography in diagnosing RAS with the digital subtraction angiography（DSA）result as the gold standard were retrieved from the databases of Pubmed,EBSCO,Springer,Ovid,CNKI and Cochrane library from their establishment to December 2013.The literatures were screened according to the inclusion criteria recommended by the Cochrane collaboration network and the included literatures were performed the quality evaluation.Subsequently,the detailed data were extracted from the included literatures.The Meta Disc 1.4software was adopted to perform the heterogeneity test and pooled the sensitivity,specificity,positive likelihood ration（PLR）,negative likelihood ration（NLR）and diagnostic odds ration（DOR）.Then,the summary receiver operating characteristic curve（SROC）was drawn;the area under curve（AUC）was calculated.The sensitivity analysis was carried on.Results Totally 9articles were included.No threshold value effect among various researches and no obvious heterogeneity were found.The fixed effect model was adopted to conduct the meta analysis,the pooled indicators like sensitivity,specificity,PLR,NLR and DOR were0.975（95%CI：0.956-0.987）,0.945（95%CI：0.923-0.962）,12.656（95%CI：9.116-17.573）,0.040（95%CI：0.024-0.067）and 412.23（95%CI：204.65-830.38）,respectively.AUC was 0.987.The Q index was 0.951.The sensitivity analysis demonstrated that the included literatures had good stability.Conclusion CTA is an effective and feasible noninvasive imaging examination method and has higher sensitivity and higher specificity for diagnosing RAS with any degree,but the mild and severe stenosis diagnosed by CTA should be treated with caution,especially mild stenosis.