冠状动脉CTA联合CT心肌灌注成像诊断冠心病:Meta分析

Coronary CTA combined CT myocardial perfusion imaging in diagnosis of coronary artery disease:Meta-analysis

目的采用Meta分析评估冠状动脉CT血管成像(CCTA)联合心肌CT灌注成像(CTP)诊断冠心病的价值。方法检索PubMed、Wed of Science、Cochrane Library、中文学术期刊数据库(CNKI)及万方数据库自建库以来至2016年12月、国内外公开发表的、关于CCTA联合心肌CTP诊断冠心病的中英文文献。按照诊断试验标准筛选文献,采用诊断准确性研究的质量评价工具-2(QADAS-2)评分标准进行质量评价,采用Meta-disc 1.4软件分析合并效应量并绘制汇总受试者工作特征(SROC)曲线,计算曲线下面积(AUC)。结果共纳入5篇文献,共611支冠状动脉,在血管水平CCTA联合CTP合并敏感度、特异度、诊断比值比、阳性似然比、阴性似然比及各自的95%可信区间分别为0.96(0.92,0.98)、0.91(0.88,0.94)、206.14(100,424.94)、9.33(5.57,15.61)、0.06(0.03,0.13);SROC曲线的AUC为0.977。结论冠状动脉CTA联合心肌CTP对冠心病具有较高的诊断价值。

Objective To assess the diagnostic value of coronary CTA（CCTA）combined myocardial CT perfusion imaging（CTP）in coronary artery disease（CAD）with Meta-analysis.Methods Chinese and English literatures evaluating CCTA combined CTP in diagnosis of CAD in PubMed,Wed of Science,Cochrane Library,China National Knowledge Infrastructure（CNKI）and Wanfang Periodical Database from inception to December 2016 were searched.The extraction was conducted according to the criteria for diagnostic recommended by Cochrane Method Group.The quality of included studies was assessed with quality assessment of diagnostic accuracy studies-2instrument.The statistical analysis was performed by Meta-disc 1.4software,the diagnosis efficacy was calculated and the symmetric receiver operating characteristic curves（SROC）was drawn to obtain the area under curve（AUC）.Results Five studies involving a total of 611 vessels were included.The pooled sensitivity（SEN）,specificity（SPE）,diagnostic odds ratio（DOR）,positive likelihood ratio（PLR）,negative likelihood ratio（NLR）were 0.96（95%CI[0.92,0.98]）,0.91（95%CI[0.88,0.94],206.14（95%CI[100,424.94]）,9.33（95%CI[5.57,15.61]）,0.06（95%CI[0.03,0.13]）,respectively.The AUC of SROC was 0.977.Conclusion CCTA combined CTP has significant value in diagnosis of CAD.