核素心肌灌注显像诊断PCI术后冠状动脉再狭窄的Meta分析

Radionuclide myocardial perfusion imaging in diagnosis of coronary artery restenosis after percutaneous coronary intervention: a Meta-analysis

目的通过Meta分析评估单光子发射型计算机断层扫描(SPECT)心肌灌注显像(MPI)诊断经皮冠状动脉介入治疗术(PCI)后冠状动脉(冠脉)再狭窄的效能。方法通过Pub Med、High Wire、CBMdisc、EMbase、知网、万方、维普、超星等数据库收集公开发表的SPECT-MPI诊断PCI术后冠脉再狭窄的相关文献,按纳入和排除标准筛选文献,提取效应指标数据。采用系统评价软件Meta-Disc1.4和Sata12.0软件进行分析,加权合并效应量指标,绘制SROC曲线,计算曲线面积(AUC)、Q*指数;绘制漏斗图,并进一步检验是否存在发表偏倚。结果本评价共纳入文献10篇,样本750例,病变冠脉855支。以患者为研究对象,纳入文献6篇,患者360例,SPECT-MPI诊断的敏感性(Sen)、特异性(Spe)及其95%CI分别为0.88(0.83~0.92)、0.83(0.77~0.89),AUC和Q*指数分别为0.92、0.85;以冠脉为研究对象,纳入文献8篇,冠脉763支,诊断的敏感性(Sen)、特异性(Spe)及其95%CI分别为0.86(0.82~0.90)、0.89(0.86~0.92),AUC和Q*指数分别为0.94、0.88。结论 MPI诊断PCI术后冠脉再狭窄的效能高,可为临床治疗方案的制定提供指导。

Objective To review the efficacy of single photon emission computed tomography myocardial perfusion imaging(SPECT MPI) in diagnosis of coronary artery restenosis after percutaneous coronary intervention(PCI) through Meta-analysis. Methods The databases of Pub Med, High Wire, CBMdisc, EMbase, CNKI, Wan Fang Database, VIP Database and superstar database were retrieved for collecting published documents related to coronary restenosis after PCI diagnosed by SPECT-MPI. All documents were screened according to inclusion and exclusion criteria to extract effect indicator data, and analyzed by using Meta-Disc1.4 software and Sata12.0 software. The effect indicators were weightedly merged, SROC curve and funnel plot were drawn, AUC and Q* index were calculated, and publication bias was tested further. Results There were totally 10 documents, 750 sample cases and 855 diseased coronary branches. When taking patients as research objects, there were 6 documents included involving 360 cases. The sensitivity was 0.88(95%CI: 0.83~0.92), specificity was 0.83(95%CI: 0.77~0.89), AUC was 0.92 and Q* index was 0.85. When taking coronary artery as research objects, there were 8 documents included involving 763 coronary branches. The sensitivity was 0.86(95%CI: 0.82~0.90), specificity was 0.89(95%CI: 0.86~0.92), AUC was 0.94 and Q* index was 0.88. Conclusion MPI is highly effective in diagnosis of coronary restenosis, which can guide the making of clinical treatment plan.