MMSE与MoCA筛查卒中后认知障碍准确性的meta分析

目的：系统评价简易精神状态检查量表与蒙特利尔认知评估量表评估卒中后认知障碍的准确性。 方法：检索万方数据库、中国知网、PubMed数据库、EMBASE数据库、Cochrane临床试验数据库自建库至2017年10月发表的文献。依据纳排标准对文献进行筛选，采用QUADAS-2工具对文献进行质量评价，应用Metadisc 1.4软件进行异质性分析，分别计算MMSE与MoCA的合并敏感度、合并特异度、合并阳性似然比和合并阴性似然比、合并后的诊断优势比，获得合并SROC曲线下面积（AUC），并对比两者的诊断准确性。 结果：研究纳入12篇文献，包括1072例患者。合并效应量结果显示，MMSE合并DOR为8.27（95%CI＝4.11～16.64），合并敏感度为68.9%（95%CI＝63.9%～72.1%），合并特异度为73.4%（95%CI＝71.6%～79%），合并PLR为2.68（95%CI＝1.86～3.85），合并NLR为0.41（95%CI＝0.27～0.62），合并AUC为0.806。MoCA合并DOR为14.05（95%CI＝9.07～21.78），合并敏感度为78.4%（95%CI＝73.7%～82.7%），合并特异度为73.7%（95%CI＝68.5%～78.4%），合并PLR为4.14（95%CI＝2.26～7.61），合并NLR为0.29（95%CI＝0.19～0.41），合并AUC为0.868。两量表对比的RDOR值为1.70，P值为0.14。结论：MoCA量表的诊断敏感性高于MMSE，特异度略高于MMSE，整体来说两者筛查PSCI的准确性均较高。建议使用者依据具体环境与患者情况，首选MoCA量表或者两者配合使用。

Test accuracy of MMSE and MoCA for diagnosis of post stroke cognitive impairment: a meta-analysis

Objective: To systematic assess the test value of mini-mental state examination(MMSE) and Montreal cognitive assessment (MoCA) in the diagnosis of post stroke cognitive impairment(PSCI).Methods: An extensive search for related literature from the Wanfang data, CNKI, PubMed, Embase and the Cochrane library up to October 2017 was performed. The articles were included according to the inclusion criteria.The quality of the studies was assessed using the QUADAS-2.Heterogeneity, pooled sensitivity, pooled specificity, pooled positive likelihood ratio(PLR), pooled negative likelihood ratio (NLR), pooled diagnostic odds ratio(DOR) were analyzed by Metadisc 1.4, the area under curve(AUC) of pooled SROC was obtained. The diagnostic accuracy between MMSE and MoCA were compared. Results: 12 studies, including a total of 1072 patients. For MMSE, the studies showed that the pooled DOR was 8.27 95% confidence interval（95%CI =4.11～16.64）, the pooled sensitivity was 68.9%(95%CI = 63.9%～72.1%),the pooled specificity was 73.4%（95%CI＝71.6%～79.0%）, the pooled PLR was 2.68（95%CI＝1.86～3.85）, the pooled NLR was 0.41（95%CI＝0.27～0.62), and the pooled AUC was 0.806. For MoCA, the studies showed that the pooled DOR was 14.05（95%CI＝9.07～21.78）. The pooled sensitivity was 78.4%（95%CI＝73.7%～82.7%）, the pooled specificity was 73.7%（95%CI＝68.5%～78.4%）, the pooled PLR was 4.14（95%CI＝2.26～7.61）, the pooled NLR was 0.29（95%CI＝0.19～0.41）, and the pooled AUC was 0.868. The RDOR value of the two scales was 1.70（P= 0.14）. Conclusion: The sensitivity and specificity of MoCA were higher than MMSE, the overall diagnostic accuracy of these two scales were both relatively high.Users should choice MoCA or both in different situation.