经胸心脏超声对A型急性主动脉夹层诊断价值的荟萃分析

目的 系统评价经胸心脏超声(transthoracic echocardiography,TTE)在疑诊A型急性主动脉夹层早期诊断中的价值.方法 计算机检索PubMed、EMbase、The Cochrane Library、中国知网(CNKI)、万方数据库,收集有关TTE诊断A型急性主动脉夹层的诊断性试验,检索时限截至2015年12月.由2位评价者根据纳入与排除标准独立筛选文献、提取资料和评价质量后,采用Meta-Disc 1.4软件进行分析,并绘制汇总受试者工作特征(SROC)曲线、计算曲线下面积和Q*指数.结果 最终纳入9个研究,共1 631例患者.敏感性为79％,特异性为95％,阳性似然比为11.99,阴性似然比为0.22,诊断比值比为74.25,SROC曲线下面积为0.940 7,Q*指数为0.878 3.结论 TTE作为单独检查方法对A型急性主动脉夹层的早期诊断具有较高的初筛价值.但其敏感性受多因素影响,临床上尚需联合其他诊断指标,以进一步提高诊断的准确性.

Diagnostic value of transthoracic echocardiography in type A acute aortic dissection: a systematic review and meta-analysis

Objective To evaluate the diagnostic value of TTE (transthomcic echocardiography) in type A acute aortic dissection.Methods The databases of PubMed,EMbase,the Cochrane Library,CNKI and WanFang Data were searched to collect the diagnostic feature on transthoracic echocardiography for type A acute aortic dissection published before Dec 2015.Two reviewers independently screened literature according to the inclusion and exclusion criteria,extracted the data,and assessed the methodological quality.Then,Meta-Disc software (Version 1.4) was used to carry out statistical analyses,draw the summary receiver operating characteristic (SROC) curve,and calculate the area under curve and Q* index.Results A total of 9 studies involving 1 631 patients were included.The values of sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio,area under of SROC curve,and Q* index were 79％,95％,11.99,0.22,74.25,0.940 7,and 0.878 3,respectively.Conclusions This Meta-analysis shows that TTE as a single indicator has high accuracy for early diagnosing type A aortic dissection.It should be combined with other diagnostic indicators to further improve the sensitivity and accuracy in diagnosing type A aortic dissection.