CT前瞻性心电门控技术对先天性心脏病诊断价值的Meta分析

摘要

Objective To evaluate the clinical diagnostic value of prospective electrocardiograph (ECG)-gating of CT cardiac angiography in congenital heart diseases of Chinese population through a Meta-analysis.Methods The articles were searched to study CT prospective ECG-gating in diagnosis of congenital heart disease from January 1995 to February 2016 in domestic and foreign publications.The study quality was assessed by the Quality Assessment for Diagnostic Accuracy Studies and the data extraction was performed.The software of Meta-disc1.4 was used for heterogeneity test.Different effect models were choosen according to the results of heterogeneity analysis.Meanwhile,this soft was used to calculate the sensitivity,specificity,likelihood ratio and its 95％ confidence interval (CI),respectively.The forest maps and summary receiver operator characteristic (SROC) curve were drawn.In addition,the area under curve (AUC) was calculated.Results Twelve articles were included in the Meta-analysis.The study included 1 431 congenital heart malformations confirmed by surgery or cardiac catheterization angiography.CT prospective ECG-gating technique had no heterogeneity in sensitivity and specificity of congenital heart disease.The total sensitivity,the total specificity,positive likelihood ratios,negative likelihood ratios and its 95％ CI of CT cardiac angiography were 96％ (95％ CI 94％ to 97％),100％ (95％ CI 100％ to 100％),365.94(95％ CI 231.18 to 579.26),0.04(95％ CI 0.03 to 0.05) with fixed effect model,respectively.The AUC of the SROC was 99.86％,Q =0.987 9.Conclusions Prospectively ECG-gating of CT cardiac angiography has high sensitivity and specificity in the diagnosis of congenital heart diseases.Its AUC of the SROC is large.It has high diagnostic value in congenital heart diseases.%目的 利用Meta分析探讨CT前瞻性心电门控技术对先天性心脏病的临床诊断价值.方法 对1995年1月至2016年2月国内外文献发表的多层螺旋CT前瞻性心电门控技术在先天性心脏病诊断的研究进行Meta分析,采用Cochrane协作网的质量评价工具偏倚评价标准对纳入文献进行质量评价,运用Meta-disc1.4软件进行异质性检验选用不同的效应模型,计算敏感性、特异性、似然比及其95％置信区间(CI),绘制森林图及综合受试者工作特征(SROC)曲线,并计算曲线下面积(AUG).结果 共12篇文献符合纳入标准.手术或心导管造影检查证实共计1 431处先天性心脏病畸形.CT前瞻性心电门控技术对先天性心脏病诊断灵敏度及特异度均不存在异质性,采用固定效应模型合并后的总灵敏度、总特异度、阳性似然比、阴性似然比及95％ CI分别为96％(95％ CI 94％～97％)、100％(95％ CI 100％～100％)、365.94(95％CI231.18～ 579.26)、0.04(95％ CI0.03 ～ 0.05).SROC AUC为99.86％,Q指数=0.987 9.结论 CT前瞻性心电门控技术在先天性心脏病诊断中有较高的灵敏度和特异度,SROC AUC较大,具有较高的诊断价值.