18氟-脱氧葡萄糖-正电子发射计算机断层扫描对大动脉炎疾病活动性诊断和评估的Meta分析

18F-Fluorodeoxyglucose positron emision tomography in the assessment of disease activity of Takayasu arteritis： a meta-analysis

目的评估正电子发射计算机断层扫描（PET）在大动脉炎疾病活动性诊断中的作用。方法文献检索基于PubMed/Medline、中国知网等数据库，纳入2016年12月前与大动脉炎和PET有关的文献。文献质量评价采用QUADAS-2，数据分析采用Meta-Disc统计软件。结果通过检索共获得文献70篇，最终纳入9篇英文文献进行Meta分析。患者疾病诊断均采用美国风湿病学会诊断分类方法。活动度评估标准多依据美国国立卫生研究院（NIH）评分，少数为临床评分。PET的结果评价采用了视觉分级或半定量方法。9项研究合并诊断比值比（DOR）为17.54，合并的敏感度和特异度分别为84%和73%，但特异度合并时具有异质性（I2=81.4%）。9项研究中有2项的结果纳入了同一患者的多次PET结果，1项研究有较多疑似活动患者最终纳入非活动组，可能影响Meta分析结果。分别通过敏感性分析去除以上研究，得到的统计结果一致性较好。去除以上研究后研究合并的DOR为30.32，敏感度为86%，特异度为85%（I2=23%）。结论PET在大动脉炎的活动性诊断和评估中具有稳定的敏感度，但特异度差异较大，可作为临床上评估方法之一。

Objective To evaluate the performance of Positron emision tomography （PET） in the assessment of disease activity of Takayasu arteritis （TA）.MethodsInformation retrieval was based on database such as PubMed/Medline and CNKI, etc. The research before Dec 2016 involving Takayasu arteritis and PET were included. The quality of the research was evaluated by diagnostic accuracy studies-2Q （UADAS-2） and the data was analyzed by Meta-disc.ResultsAmong the 70 research, nine studies were included in this study with a total of 126 patients and 254 controls. All patients were diagnosed according to the classification criteria of American College of Rheumatology. The disease activity was mostly assessed by the scoring system of National Institutes of Health and by clinical assessment in one study. The result of PET was evaluated by visual grade and semi-quantitative analysis. The pooled DOR of the 9 studies was 17.54, the pooled sensitivity and specificity was 84% and 73%, respectively. However, the heterogeneity of specificity was 81.4%. Two studies had included one patients repeatedly and suspected active patients were included in the in-active group in one study, which might impact the statistical result of the meta-analysis. After excluded these studies, the pooled DOR was 30.32. The pooled sensitivity and specificity was 86% and 85%, respectively, with better consistency.ConclusionPET shows stable sensitivity and variant specificity in the diagnosis and assess of disease activity of TA, which is a useful method in the clinically evaluation of disease activity of TA.