定量超声检测技术对骨质疏松症诊断价值的Meta分析

目的应用Meta分析法综合评价定量超声检测技术(QUS)对骨质疏松症的诊断价值。方法检索PubMed、Medline、中文科技期刊全文数据库(VIP)、中国期刊全文数据库(CNKI)和万方等数据库,检索时间为各数据库自建库起至2011年9月发表的相关文献,收集关于QUS检测技术诊断骨质疏松症的相关文献并进行信息统计和文献质量评估;采用Meta-Disc 1.4软件随机效应模型进行数据分析,计算合并敏感度、特异度、似然比及合并受试者工作特征曲线等指标。结果共纳入5篇文章,其中英文1篇,中文4篇,共844名研究对象,其中经双能X线金标准诊断的骨质疏松患者284例,非患者560例。异质性检验显示纳入研究存在异质性,通过随机效应模型计算合并敏感度为0.46(95%C.I.:0.42～0.51),合并特异度为0.73(95%C.I.:0.70～0.75),合并阳性似然比为2.43(95%C.I.:1.42～4.13),合并阴性似然比为0.66(95%C.I.:0.48～0.90),合并受试者工作特征曲线下面积为0.74。结论 QUS检测技术对骨质疏松症诊断能力尚可,但尚不能认为其具有较高的准确性,应进一步规范QUS检测方法,寻求适合中国人骨质疏松症QUS诊断阈值及检测部位,及通过更多高质量、大样本相关研究对结果进一步验证。

Diagnostic value of quantitative ultrasound test in osteoporosis : a Meta-analysis

Objective To evaluate the diagnostic value of quantitative ultrasound test in osteoporosis using Meta-analysis method.Methods PubMed,Medline,VIP,CNKI,and WANFANG databases(from the date of each database established to September,2011) were searched to collect studies evaluating the diagnostic value of quantitative ultrasound test in osteoporosis.The statistical information and quality of science of these papers were assessed.The data were analyzed using Meta-Disc1.4 software.The diagnostic value of quantitative ultrasound in osteoporosis was evaluated with the combined sensitivity,specificity,the likelihood ratio,and summary receiver operating characteristic curve.Results Five literatures were collected including 1 in English and 4 in Chinese.Eight hundred and forty-four subjects were included in the review including 284 osteoporosis patients and 560 non-osteoporosis individuals,all diagnosed with dual energy X-ray absorptiometry testing.Heterogeneity test showed that the heterogeneity was existed among the study.Using random effect models to analyze the data,the value of the weighted sensitivity was 0.46(95% CI: 0.42~0.51),the specificity was 0.73(95% CI: 0.70~0.75),the positive likelihood ratio was 2.43(95% CI: 1.42~4.13),negative likelihood ratio was 0.66(95% CI: 0.48~0.90),and the area under the summary receiver operating characteristic curve was 0.74.Conclusion The diagnostic ability of quantitative ultrasound test is fair,but may not be considered as high accuracy.Standard criterion of QUS test and appropriate cut-off values for Chinese people should be studied in the future,and more high quality studies with large sample are required to assess its clinical value.