经颅多普勒超声对大脑中动脉狭窄诊断价值的Meta分析

Value of transcranial Doppler in diagnosis of middle cerebral artery stenosis:a Meta-analysis

目的应用Meta分析评价经颅多普勒超声(TCD)对大脑中动脉(MCA)狭窄率≥50%的诊断价值,并评估血流速度的最佳诊断值。方法电子检索2000年1月1日到2017年9月30日PubMed、Web of Science、Cochrane Library、中国知网、万方及维普数据库,搜索关于评价TCD对MCA狭窄率≥50%的相关文献。采用QUADAS方法对纳入文献的质量进行评价,并对其进行统计学分析。结果最终共纳入16项研究。平均血流速度(MFV)100 cm/s和峰值血流速度(PSV)140 cm/s是TCD诊断MCA狭窄率≥50%的最佳诊断值。以DSA、MRA或CTA为参照标准时,MFV≥100 cm/s和PSV≥140 cm/s预测TCD诊断MCA狭窄率≥50%的合并敏感性为71%和75%,合并特异性为94%和91%,合并阳性似然比为13.60和10.00,合并阴性似然比为0.25和0.27。以DSA为参照标准时,MFV≥100 cm/s或PSV≥140 cm/s时TCD诊断MCA狭窄率≥50%的合并敏感性为77%和79%,合并特异性为94%和96%,合并阳性似然比为12.68和19.85,合并阴性似然比为0.23和0.22。结论不论是以DSA、MRA或CTA为参照标准,还是仅以DSA为参照标准,TCD对MCA狭窄率≥50%均具有较高的诊断价值,其MFV和PSV的最佳诊断值分别为100 cm/s和140 cm/s。TCD可以作为MCA狭窄率≥50%的筛查手段。

Objective To analyze the value of transcranial Doppler(TCD)in diagnosis of≥50%middle cerebral artery(MCA)stenosis,and to evaluate the best cutoff value of blood flow velocity by Meta-analysis.Methods By searching PubMed,Web of science,Cochrane liberary,CNKI,Wanfang and VIP database from1January2000to30September2017,all of the eligible articles which evaluated the diagnostic value of TCD for≥50%MCA stenosis were harvested.The quality of each included literature was evaluated by QUADAS tools.Statistical analysis was conducted by the Meta-Disc software.Results A total of16articles were analyzed in this Meta-analysis.The best diagnostic cutoff values of mean flow velocity(MFV)and peak systolic velocity(PSV)were≥100cm/s and≥140cm/s.Taking DSA,MRA or CTA as gold standard,the pooled sensitivity,pooled specificity,positive likelihood radio and negative likelihood ratio were0.71,0.94,13.60and0.25for MFV≥100cm/s,and0.75,0.91,10.00and0.27for PSV≥140cm/s.Taking DSA as gold standard,the pooled sensitivity,pooled specificity,positive likelihood radio and negative likelihood ratio were0.77,0.94,12.68and0.23for MFV≥100cm/s,and0.79,0.96,19.85and0.22for PSV≥140cm/s.Conclusion No matter that DSA,MRA or CTA as gold standard,or only DSA as gold standard,when MFV≥100cm/s and PSV≥140cm/s,TCD shows high value in the diagnosis of≥50%MCA stenosis,and it can be used as an effective screening test in clinical practice.