双源CT对冠状动脉支架内再狭窄诊断价值的Meta分析

目的评价双源CT在经皮冠状动脉支架置入术后支架内再狭窄的诊断价值。方法计算机检索2005年12月1日～2011年12月30日Pubmed,Embase,Cochrane library,CNKI,CBMdisc数据库,查询双源CT在诊断冠状动脉支架内再狭窄研究的中、英文文献。对纳入文献进行质量评估,计算双源CT诊断冠状动脉支架内再狭窄灵敏度（SE）、特异度（SP）及其95%可信区间（CI）,绘制及计算受试者工作特征曲线（SROC）和曲线下面积（AUC）。结果共纳入9篇文献。基于支架分析,双源CT诊断冠状动脉支架内再狭窄的合并灵敏度为0.91（95%CI：0.86～0.95）,特异度为0.92（95%CI：0.90～0.94）,AUC为0.97。双源CT对诊断冠状动脉内大支架（直径≥3mm）再狭窄的准确度高于小支架（直径〈3mm）,差异有统计学意义（P〈0.05）。不可评价支架的合并构成比为0.066（95%CI：0.05～0.09）。结论双源CT诊断冠状动脉支架内再狭窄的准确度高,适用于直径≥3mm的支架,是冠状动脉支架随访和评价的一种有效且无创的检测方法。

A Meta analysis on diagnostic value of dual-source CT to in-stent restenosis of coronary artery

Objective To review the diagnostic value of dual-source CT to in-stent restenosis of coronary artery after percutaneous coronary stent implantation.Methods The databases of Pubmed,Embase,Cochrane Library,CNKI and CBMdisc were retrieved from 1,Dec.2005 to 30,Dec.2011.The Chinese and English documents on value of dual-source CT to in-stent restenosis of coronary artery were searched,and the quality of the documents was assessed.The sensitivity(SE),specificity(SP) and 95% CI of dual-source CT to in-stent restenosis of coronary artery were calculated,and summary receiver operating characteristic(RSOC) curve and area under curve(AUC) were drawn and calculated.Results There were 9 documents enclosed.Based on stent analysis,the merger SE of dual-source CT to in-stent restenosis of coronary artery was 0.91(95%CI:0.86～0.95),SP was 0.92(95%CI:0.90～0.94) and AUC was 0.97.The accuracy of dual-source CT in diagnosis of coronary large stents(diameter≥3 mm) restenosis was higher than that of small stents(diameter<3 mm) restenosis and the difference was statistically significant(P<0.05).The merger constituent ratio of non-assessable stents was 0.066(95%CI:0.05～0.09).Conclusion The accuracy of dual-source CT in diagnosis of in-stent restenosis of coronary artery was higher,which is suitable for the stents with diameter more than 3 mm.It is an effective and non-invasive diagnostic approach in the follow-up and review of coronary stent implantation.