经颅多普勒超声与经胸超声心动图对卵圆孔未闭诊断价值比较的Meta分析

Transcranial Doppler versus Transthoracic Echocardiography in Diagnosis of Patent Foramen Ovale in Patients: A Meta-Analysis

目的:使用Meta分析的方法,比较对比增强经颅多普勒超声(c-TCD)与对比增强经胸超声心动图(c-TTE)对卵圆孔未闭(PFO)右向左分流(RLS)的诊断价值。方法:检索PubMed、Web of Science、Embase、Cochrane Library CNKI、VIP、WanFang Data及CBM数据库等自建库至2021年7月3日的文献,采用统计学软件Stata15.1和RevMan5.0进行数据统计分析。结果:共检索出766篇文献,确定纳入38篇文献。Meta分析结果显示,c-TCD的合并敏感度(0.96,95%CI 0.93~0.98)高于c-TTE(0.91,95%CI 0.82~0.96),有显著性差异(Z=2.664,P=0.008);c-TCD的合并特异度(0.93,95%CI 0.86~0.97)低于c-TTE(0.95,95%CI 0.90~0.97),差异无统计学意义(Z=0.481,P=0.630);c-TCD的合并DOR(DOR=384,95%CI 156~943)和c-TTE(DOR=180,95%CI 78~415)之间差异无统计学意义(Z=0.674,P=0.441)。c-TCD的sROC AUC大于c-TTE,差异无统计学意义(c-TCD的AUC为0.99,95%CI 0.97~0.99;c-TTE的AUC为0.98,95%CI 0.96~0.99;Z=0.357,P=0.507)。结论:c-TCD与c-TTE对PFO-RLS均具有较高的诊断价值。

Objective: Using Meta-analysis to compare diagnostic value of contrast transcranial Doppler(c-TCD) and contrast transthoracic echocardiography(c-TTE) in right-to-left shunt(RLS) of patients with patent foramen ovale(PFO). Methods: Relevant literature from PubMed, Web of Science, Embase, Cochrane Library,CNKI, VIP, WanFang Data, and CBM from databases built until July 3, 2021 were retrieved. Statistical software Stata 15.1 and RevMan5.0 were used for statistical analysis. Results: A total of 766 articles were retrieved and38 were included. Meta-analysis results showed the overall sensitivity of c-TCD(0.96, 95%CI 0.93~0.98) was higher than that of c-TTE(0.91, 95%CI 0.82 ~ 0.96), and the difference was statistically significant(Z=2.664, P=0.008). The overall specificity of c-TCD(0.93, 95%CI 0.86~0.97) was lower than that of c-TTE(0.95, 95%CI0.90 ~ 0.97), but the difference was not statistically significant(Z=0.481, P=0.630). The diagnostic odds ratio of c-TCD(DOR=384, 95%CI 156~943) and c-TTE(DOR=180, 95%CI 78~415) showed no significant statistical difference(Z=0.674, P=0.441). The area under the s ROC curve(AUC) of c-TCD was higher than that of c-TTE but showed no statistical difference(AUC=0.99, 95% CI 0.97~0.99 for c-TCD v.s. AUC=0.98, 95% CI 0.96~0.99 for c-TTE;Z=0.357, P=0.507). Conclusion: For the diagnosis of PFO-RLS, both c-TCD and c-TTE have high diagnostic value.