^(99)Tc^(m)-PYP SPECT/CT显像对转甲状腺素蛋白相关心脏淀粉样变诊断效能的Meta分析

Meta-analysis of diagnostic efficiency of^(99)Tc^(m)-PYP SPECT/CT scintigraphy for transthyretin-related cardiac amyloidosis

目的对^(99)Tc^(m)-焦膦酸盐(PYP)SPECT/CT显像诊断转甲状腺素蛋白相关心脏淀粉样变(ATTR-CA)的研究行Meta分析,探究视觉评分、心脏/对侧肺(H/CL)比值对ATTR-CA的诊断效能。方法于Pubmed、EMbase、Cochrane Library、Web of Science、中国知识基础设施工程(CNKI)、万方数据知识服务平台(Wanfang)、中文科技期刊数据库(VIP)等数据库检索2023年8月20日前发表的^(99)Tc^(m)-PYP SPECT/CT显像诊断ATTR-CA的相关研究,筛选文献并提取反映诊断效能的指标(灵敏度、特异性),绘制森林图,行亚组分析探讨异质性。结果共检索文献160篇,纳入11篇,纳入研究患者1802例,其中605例被诊断为ATTR-CA。分析视觉评分时,纳入全部文献11篇,整合后其诊断ATTR-CA的灵敏度为0.95(95%CI:0.91~0.97),特异性为0.95(95%CI:0.90~0.98);分析H/CL比值时,纳入文献10篇,患者1611例,整合后其诊断ATTR-CA的灵敏度为0.93(95%CI:0.82~0.98),特异性为0.99(95%CI:0.90~1.00)。亚组分析显示确诊标准不统一是研究异质性的主要来源。结论^(99)Tc^(m)-PYP SPECT/CT显像对ATTR-CA的诊断效能高。

ObjectiveTo discuss the performance of visual score and heart-to-contralateral lung(H/CL)ratio of^(99)Tc^(m)-pyrophosphate(PYP)SPECT/CT scintigraphy for diagnosing transthyretin-related cardiac amyloidosis(ATTR-CA)by using Meta-analysis.MethodsRelevant studies on^(99)Tc^(m)-PYP SPECT/CT diagnosis of ATTR-CA published before August 20,2023 from databases including Pubmed,EMbase,Cochrane Library,Web of Science,China National Knowledge Infrastructure(CNKI),Wanfang and China Science and Technology Journal Database(VIP)were retrieved.Articles were screened and indices which reflect the diagnostic efficiency such as sensitivity and specificity were extracted.Forest plots were drawn,and subgroup analysis was performed to analyze the heterogeneity.ResultsA total of 160 articles were retrieved,and 11 articles involving 1802 patients were enrolled,of whom 605 were diagnosed with ATTR-CA.All 11 articles were enrolled when analyzing the diagnostic efficiency of visual score for diagnosing ATTR-CA.After integration,the sensitivity and specificity were 0.95(95%CI:0.91-0.97)and 0.95(95%CI:0.90-0.98),respectively.Ten articles(1611 patients)were enrolled when analyzing the diagnostic efficiency of H/CL ratio for diagnosing ATTR-CA.After integration,the sensitivity and specificity were 0.93(95%CI:0.82-0.98)and 0.99(95%CI:0.90-1.00),respectively.Subgroup analysis indicated that lack of uniformity in diagnostic criteria was the primary source of heterogeneity.Conclusion^(99)Tc^(m)-PYP SPECT/CT scintigraphy exhibits high diagnostic efficiency for ATTR-CA.