超声和CT测量视神经鞘直径与眼球横径比值诊断颅内压增高的Meta分析

The ratio of optic nerve sheath diameter to eyeball transverse diameter measured by ultrasound and CT for the diagnosis of increased intracranial pressure:Meta analysis

目的采用Meta分析方法评估超声和CT测量视神经鞘直径(optic nerve sheath diameter,ONSD)与眼球横径(eyeball transverse diameter,ETD)比值诊断颅内压(intracranial pressure,ICP)增高的准确性及最佳阈值。方法检索自建库至2024年3月15日万方医学网、维普数据库、中国知网、中国生物医学文献服务系统(SinoMed)、PubMed、Web of Science、Embase数据库收录的关于ONSD/ETD比值评估ICP增高的文献并进行筛选,由两名独立的作者提取相关数据,使用QUADAS-2工具进行文献质量偏倚评估,随机效应模型汇总合并敏感度、特异度和诊断比值比。采用Stata17.0、Revman5.4.1等软件对数据进行分析,评估ONSD/ETD比值诊断ICP增高的准确性及最佳阈值。结果最终纳入11篇文献(包括807例患者)。超声测量ONSD/ETD比值诊断ICP增高的合并敏感度和特异度分别为0.89(95%CI 0.85~0.92)和0.82(95%CI 0.74~0.87),阳性和阴性似然比分别为4.8(95%CI 3.4~6.8)和0.14(95%CI 0.10~0.18),诊断比值比为35(95%CI 21~60),总受试者工作特征(SROC)的曲线下面积(AUC)为0.90(95%CI 0.87~0.93),最佳阈值为0.248 mm;采用计算机断层扫描(CT)测量ONSD/ETD比值诊断ICP增高的合并敏感度和特异度分别为0.77(95%CI 0.66~0.85)和0.78(95%CI 0.66~0.86),阳性和阴性似然比分别为3.5(95%CI 2.1~5.8)和0.29(95%CI 0.19~0.46),诊断比值比为12(95%CI 5~29),AUC为0.84(95%CI 0.81~0.87),最佳阈值为0.250 mm。结论超声测量ONSD/ETD比值在诊断ICP增高的准确性方面可能优于CT测量,且更安全、方便,床旁可操作,最佳阈值为0.248 mm。但由于纳入的文献数量相对较少以及纳入研究中引起患者ICP增高的病因存在差异,可能对研究结果的普适性和可靠性产生一定影响。

Objective To evaluate the accuracy and optimal threshold of the ratio of optic nerve sheath diameter(ONSD)to eyeball transverse diameter(ETD)measured by ultrasound and CT in diagnosing increased intracranial pressure(ICP)by Meta analysis.Methods Literatures on ONSD/ETD for evaluating increased ICP was retrieved from Wanfang Medical Database,VIP databases,CNKI,SinoMed,PubMed,Web of Science and Embase from inception to March 15,2024.Two independent authors extracted relevant data and assessed the bias of literature quality by using the QUADAS-2 tool,and a random effects model was employed to calculate pooled sensitivity,specificity and diagnostic odds ratios.Data analysis was conducted by using Stata 17.0 and Revman 5.4.1 for assessing the accuracy of optimal threshold of the ONSD/ETD in diagnosing increased ICP.Results Eleven studies encompassing 807 patients were included.The pooled sensitivity and specificity of ultrasound ONSD/ETD for diagnosing increased ICP were 0.89(95%CI 0.85-0.92)and 0.82(95%CI 0.74-0.87)with positive and negative likelihood ratios of 4.8(95%CI 3.4-6.8)and 0.14(95%CI 0.10-0.18),respectively.The diagnostic odds ratio was 35(95%CI 21-60),and the area under the curve(AUC)for the summary receiver operating characteristic(SROC)was 0.90(95%CI 0.87-0.93).The optimal threshold was 0.248 mm.For ONSD/ETD by CT measurements,the pooled sensitivity and specificity were 0.77(95%CI 0.66-0.85)and 0.78(95%CI 0.66-0.86)with positive and negative likelihood ratios of 3.5(95%CI 2.1-5.8)and 0.29(95%CI 0.19-0.46).The diagnostic odds ratio was 12(95%CI 5-29)and the AUC was 0.84(95%CI 0.81-0.87)with the optimal threshold of 0.250 mm.Conclusions Ultrasound measurement of the ONSD/ETD ratio is more accurate than CT measurement of the ONSD/ETD ratio for diagnosing increased ICP,offering a safer,more convenient,and bedside-operable option,and the optimal threshold was 0.248 mm.However,due to the relatively small number of included studies and the differences in the causes of increased ICP among the patients in these studies,there may be some impact on the universality and reliability of the research results.