64排螺旋CT冠状动脉成像评价冠状动脉狭窄准确性的Meta分析

Accuracy of 64-row coronary computed tomography angiography for diagnosis of coronary artery stenosis: meta-analysis

摘要:

目的  对以侵入性冠状动脉造影（ICA）为金标准，研究64排螺旋CT冠状动脉成像（64-row CCTA）诊断冠状动脉狭窄的文献进行Meta分析，评价64-row CCTA对冠状动脉狭窄的临床诊断价值。方法  检索Cochrane图书馆、OVID循证医学数据库、PubMed、中国期刊网中的中、英文文献。按照Cochrane协作网推荐的诊断试验纳入标准筛选文献，提取纳入研究的特征信息。数据分析采用RevMan 5.3统计软件，检验异质性，并根据异质性结果选择相应的效应模型。对所有研究进行加权定量合并，计算汇总敏感性（Se）、汇总特异性（Sp）及95%可信区间（CI）。绘制汇总受试者工作特征曲线（SROC），计算曲线下面积。结果  共纳入69篇文献，均存在异质性，按照随机效应模型，汇总Se=0.92，95%CI=（0.91，0.92）；汇总Sp=0.95，95%CI=（0.95，0.96）；SROC曲线下面积为98.60%。结论  64-row CCTA诊断冠状动脉狭窄具有较高的Se和Sp，是一种高效、无创的检查方法。

Abstract:

Objective To assess the overall value of 64-row coronary computed tomography angiography (64-row CCTA) in diagnosis of coronary artery stenosis with invasive coronary angiography (ICA) as the gold standard. Methods A search in Cochrane Library, OVID, PubMed and CNKI was performed to identify relevant English and Chinese language articles. Criteria for inclusion were established based on validity criteria for diagnostic research published by the Cochrane Methods Group on Screening and Diagnostic Tests. Subsequently, the characteristics of the included articles were appraised and extracted. Statistical analysis was performed employing RevMan 5.3, Meta-Disc 1.4. Heterogeneity of the included articles was tested, which was used to select proper effect model. Pooled weighted sensitivity and specificity were calculated. Summary Receiver Operating Characteristic (SROC) curve was drawn and the area under the curve (AUC) was calculated. Results Of the 479 retrieved articles, 69 were included. The pooled weighted sensitivity and specificity with 95% confidence interval (95% CI) were 0.92 (0.91-0.92) and 0.95 (0.95-0.96), respectively. The area under the SROC curve was 98.60%. Conclusions 64-row CCTA has a highly accurate sensitivity and specificity with a strong ROC curve making it an alternative non-invasive method in the diagnosis of coronary artery stenosis.