螺旋CT及经食管超声心动图诊断疑似主动脉夹层价值的Meta分析

Diagnostic value of CT and transesophageal echocardiography for suspected aortic dissection:a Meta analysis

目的系统评价螺旋CT及经食管超声心动图诊断疑似主动脉夹层人群的价值。方法检索中英文数据库关于疑似主动脉夹层前瞻性诊断的研究,纳入文献质量以Quality Assessment of Diagnostic Accuracy Studies进行评估,以Review Manager及Meta-DiSc软件对纳入研究进行分析。结果最终纳入15篇研究。Meta结果示,CT诊断主动脉夹层的灵敏度为0. 98,95%CI(0. 93,0. 98);特异度为0. 91,95%CI (0. 87,0. 95);阳性似然比为15. 39,95%CI (4. 31,55. 00);阴性似然比为0. 06,95%CI(0. 03,0. 10);诊断比值比为392. 92,95%CI(66. 31,2 328. 34);曲线下面积为0. 987 7;经食管超声心动图诊断主动脉夹层的灵敏度为0. 94,95%CI(0. 91,0. 96);特异度为0. 96,95%CI(0. 93,0. 98);阳性似然比为14. 70,95%CI(7. 65,28. 24);阴性似然比为0. 06,95%CI(0. 03,0. 13); TEE的诊断比值比为324. 06,95%CI(97. 42,1 077. 97);曲线下面积为0. 9811。CT和TEE诊断主动脉夹层价值差异无统计学意义(Z=0. 305 4,P> 0. 05).结论螺旋CT及经食管超声心动图对疑似主动脉夹层的人群均有较高的诊断价值。

The prospective studies on the diagnosis of suspected aortic dissection were searched from Chinese and English database,and Review Manager and Meta-DiSc software were used to analyze the data after evaluating the quality of documents by quality assessment of diagnostic accuracy studies.Results Totally 15 studies were involved.Meta-analysis showed that the sensitivity of CT in the diagnosis of aortic dissection was 0.98[95%CI(0.93,0.98)],the specificity was 0.91[95%CI(0.87,0.95)],the positive likelihood ratio was 15.39[95%CI(4.31,55.00)],the negative likelihood ratio was 0.06[95%CI(0.03,0.10)],the ratio of diagnostic ratio was 392.92[95%CI(66.31,2 328.34)],and the area under the curve was 0.987 7.The sensitivity of transesophageal echocardiography in the diagnosis of aortic dissectio was 0.94[95%CI(0.91,0.96)],the specificity was 0.96[95%CI(0.93,0.98)],the positive likelihood ratio was 14.70[95%CI(7.65,28.24)],the negative likelihood ratio was 0.06[95%CI(0.03,0.13)],the diagnostic ratio of TEE was 324.06[95%CI(97.42,1 077.97)],and the area under the curve was 0.981 1.There was no statistical difference in diagnosis of suspected aortic dissection between two methods(Z=0.305 4,P>0.05).Conclusion Spiral CT and transesophageal echocardiography both have high diagnostic value for suspected aortic dissection.