Meta分析64层螺旋CT对冠状动脉狭窄或阻塞的诊断价值

目的探讨用Meta分析方法评价64层螺旋CT对冠状动脉狭窄的诊断价值。方法在Medline、Cochrane图书馆及中国数字化期刊网/万方数据库检索2005年1月~2007年3月有关64层螺旋CT对比冠状动脉造影在冠状动脉疾病诊断价值的文献。数据处理采用随机效应模型。结果共纳入16篇参考文献的关于64层螺旋CT对比冠状动脉造影的应用研究,冠状动脉节段共计12615段,4.2%的冠状动脉段无法评价被排除。冠状动脉总体敏感性90.7%,特异性95.9%,阳性似然比23.05,阴性似然比0.08,阳性预测值83.6%,阴性预测值97.3%,OR值297.37,SROC曲线下面积0.9876。结论64层螺旋CT在冠心病高危人群有很高的诊断价值,可以作为重要的筛查和诊断方法之一。

Meta-analysis of diagnostic value of 64-slice spiral computed tomography for coronary artery disease

Objective To define the value of 64-slice spiral computed tomography for the diagnosis of coronary artery disease(CAD)using a meta-analytic method.Methods Using Medline,Cochrane library and CNKI(including Wanfang Database),16 studies(2024 patients)evaluating CAD by means of both 64-slice spiral computed tomography and conventional coronary angiography from Jan 2005 to Mar 2007 were identified.After data extraction,the analysis was performed according to a random-effect model.Results The per-segment analysis pooled the results from 16 studies corresponding to a cumulative number of 12615 segments.Of the unassessable segments,4.2% were excluded from the analysis and 6.4% were classified at the discretion of the investigators,underscoring the shortcomings of MSCT.With this major limitation,the per-segment sensitivity and specificity were 90.7% and 95.9%,respectively,positive likelihood ratio was 23.05,negative likelihood ratio was 0.08,positive and negative predictive values were 83.6% and 97.3% respectively,OR was 297.37,and AUC of SROC was 0.9876.Conclusion 64-slice spiral computed tomography which has moderate sensitivity and specificity in patients with high risk for CAD can be proposed as an important screening and diagnostic method.At present,such limiting foctors as high heart rate,heart rate aberration and heavy calcification are the obstacles for application of 64-slice spiral computed tomography.