磁共振肺動脈造影對肺動脈栓塞診斷價值的Meta 分析_《中國呼吸與危重監護雜志》

作者：

張有志 , 夏敬文 , 楊海華 , 龍豐 , 陳小東

復旦大學附屬華山醫院( 上海200040)通信作者: 陳小東, E-mail: xiaodongch1963@ yahoo. cn;

關鍵詞：

磁共振血管造影肺栓塞 Meta 分析

DOI：

DOI: 10 . 7507 /1671 -6205 . 20130120

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目的應用Meta 分析法綜合評價磁共振肺動脈造影( MRA) 診斷急性肺栓塞( PE) 的價值。
方法在Cochrane 圖書館、Medline 和Embase 數據庫和萬方、中國生物醫學文獻數據庫檢索1990 年1 月至2012 年12 月發表的相關英文和中文文獻; 根據Cochrane 協作網推薦的診斷試驗的納
入標準篩選符合條件的文獻, 對文獻進行信息統計、科學性評估及質量分級, 提取納入研究的特征信息; 數據分析采用Meta-disc 1.4 軟件, 檢驗異質性, 根據異質性檢驗結果選擇相應的效應模型進行數
據分析; 通過匯總似然比( LR) , 匯總敏感度和特異度及匯總受試者工作特征曲線( SROC 曲線) 等統計指標綜合評價MRA 在PE 中的診斷價值。
結果共納入6 篇英文文獻, 534 例研究對象。異質性檢驗提示有閾值效應, 按隨機效應模型進行Meta 分析得出MRA 在PE 中診斷價值的匯總陽性似然比為32. 392 ( 15. 951 ～65. 778) , 匯總陰性似然比為0. 217( 0. 160 ～0. 294) , 匯總敏感度為0. 800( 0. 728 ～0. 860) , 匯總特異度為0. 984( 0. 966 ～0. 994) , SROC 曲線下面積( AUC) 為0. 9783。
結論 MRA 是診斷肺栓塞有價值的方法, 特別適用于有腎功能不全和造影劑過敏的患者, 此外還可避免放射線暴露。

引用本文： 張有志,夏敬文,楊海華,龍豐,陳小東. 磁共振肺動脈造影對肺動脈栓塞診斷價值的Meta 分析. 中國呼吸與危重監護雜志, 2013, 12(5): 499-504. doi: DOI: 10 . 7507 /1671 -6205 . 20130120 復制

1.	Furlan A, Aghayev A, Chang CC, et al. Short-term mortality in acute pulmonary embolism: clot burden and signs of right heart dysfunction at CT pulmonary angiography. Radiology, 2012, 265 :283 -293.
2.	Stein PD, Athanasoulis C, Alavi A, et al. Complications and validity of pulmonary angiography in acute pulmonary embolism.Circulation, 1992, 85: 462-468.
3.	den Exter PL, Klok FA, Huisman MV. Diagnosis of pulmonary embolism: Advances and pitfalls. Best Pract Res Clin Haematol,2012, 25: 295-302.
4.	Battaglia M, Bucher H, Egger M, et al. The Bayes Library of Diagnostic Studies and Reviews. 2nd edition. 2002.5 Sackett DL, Straus SE, Rithardson WS. Evidence-based medicine:How to practice and teach EBM. 2nd edition. London: Chrchill Livingstone. 2000, 169-182 .
5.	Stein PD, Chenevert TL, Fowler SE, et al. Gadolinium-enhanced magnetic resonance angiography for pulmonary embolism: a multicenter prospective study ( PIOPED III ) . Ann Intern Med,2010, 152 : 434-443.
6.	Pleszewski B, Chartrand-Lefebvre C, Qanadli SD, et al.Gadolinium-enhanced pulmonary magnetic resonance angiography in the diagnosis of acute pulmonary embolism: a prospective study on.
7.	Oudkerk M, van BEJ, Wielopolski P, et al. Comparison of contrastenhanced magnetic resonance angiography and conventional pulmonary angiography for the diagnosis of pulmonary embolism: aprospective study. Lancet, 2002 , 359: 1643 -1647 .
8.	Gupta A, Frazer CK, Ferguson JM, et al. Acute pulmonary embolism: diagnosis with MR angiography. Radiology, 1999 , 210 :353-359.
9.	Meaney JF, Weg JG, Chenevert TL, et al. Diagnosis of pulmonary embolism with magnetic resonance angiography. N Engl J Med,1997, 336: 1422-1427.
10.	Loubeyre P, Revel D, Douek P, et al. Dynamic contrast-enhanced MR angiography of pulmonary embolism: comparison with pulmonary angiography. AJR Am J Roentgenol, 1994, 162 : 1035 -.
11.	Stein PD, Fowler SE, Goodman LR, et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med, 2006 ,354: 2317-2327.
12.	Blum A, Bellou A, Guillemin F, et al. Performance of magnetic resonance angiography in suspected acute pulmonary embolism.Hrombosis & Haemostasis, 2005, 93: 503-511 .
13.	Stein PD, Woodard PK, Hull RD, et al. Gadolinium-enhanced magnetic resonance angiography for detection of acute pulmonary embolism: an in-depth review. Chest, 2003, 124: 2324-2328.
14.	Jacschke R, Guyart GH, Sackett DL, et al. Users’guides to the medical literature. III. How to use an artical about a diagnostic test.B. What are the results and will they help me in caring for mypatients? The Evidence-Based Medicine Working Group. JAMA,1994, 271: 703-707.
15.	Salaun PY, Couturaud F, Le DA, et al. Noninvasive diagnosis of pulmonary embolism. Chest, 2011 , 139: 1294 -1298 .
16.	Safriel Y, Zinn H. CT pulmonary angiography in the detection of pulmonary emboli: a meta-analysis of sensitivities and specificities.Clin Imaging, 2002, 26: 101-105.
17.	郭佑民, 張少娟, 楊健, 等. CT 動脈造影對肺動脈栓塞診斷價值的Meta 分析. 中華放射學雜志, 2004 , 38: 706-710.
18.	Moses LE, Shapiro D, Littenberg B. Combining independent studies of a diagnostic test into a summary ROC curve: data-analytic approaches and some additional considerations. Stat Med, 1993, 12 :1293-1316.
19.	patients. Clin Imaging, 2006, 30 : 166-172.
20.	.

1. Furlan A, Aghayev A, Chang CC, et al. Short-term mortality in acute pulmonary embolism: clot burden and signs of right heart dysfunction at CT pulmonary angiography. Radiology, 2012, 265 :283 -293.
2. Stein PD, Athanasoulis C, Alavi A, et al. Complications and validity of pulmonary angiography in acute pulmonary embolism.Circulation, 1992, 85: 462-468.
3. den Exter PL, Klok FA, Huisman MV. Diagnosis of pulmonary embolism: Advances and pitfalls. Best Pract Res Clin Haematol,2012, 25: 295-302.
4. Battaglia M, Bucher H, Egger M, et al. The Bayes Library of Diagnostic Studies and Reviews. 2nd edition. 2002.5 Sackett DL, Straus SE, Rithardson WS. Evidence-based medicine:How to practice and teach EBM. 2nd edition. London: Chrchill Livingstone. 2000, 169-182 .
5. Stein PD, Chenevert TL, Fowler SE, et al. Gadolinium-enhanced magnetic resonance angiography for pulmonary embolism: a multicenter prospective study ( PIOPED III ) . Ann Intern Med,2010, 152 : 434-443.
6. Pleszewski B, Chartrand-Lefebvre C, Qanadli SD, et al.Gadolinium-enhanced pulmonary magnetic resonance angiography in the diagnosis of acute pulmonary embolism: a prospective study on.
7. Oudkerk M, van BEJ, Wielopolski P, et al. Comparison of contrastenhanced magnetic resonance angiography and conventional pulmonary angiography for the diagnosis of pulmonary embolism: aprospective study. Lancet, 2002 , 359: 1643 -1647 .
8. Gupta A, Frazer CK, Ferguson JM, et al. Acute pulmonary embolism: diagnosis with MR angiography. Radiology, 1999 , 210 :353-359.
9. Meaney JF, Weg JG, Chenevert TL, et al. Diagnosis of pulmonary embolism with magnetic resonance angiography. N Engl J Med,1997, 336: 1422-1427.
10. Loubeyre P, Revel D, Douek P, et al. Dynamic contrast-enhanced MR angiography of pulmonary embolism: comparison with pulmonary angiography. AJR Am J Roentgenol, 1994, 162 : 1035 -.
11. Stein PD, Fowler SE, Goodman LR, et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med, 2006 ,354: 2317-2327.
12. Blum A, Bellou A, Guillemin F, et al. Performance of magnetic resonance angiography in suspected acute pulmonary embolism.Hrombosis & Haemostasis, 2005, 93: 503-511 .
13. Stein PD, Woodard PK, Hull RD, et al. Gadolinium-enhanced magnetic resonance angiography for detection of acute pulmonary embolism: an in-depth review. Chest, 2003, 124: 2324-2328.
14. Jacschke R, Guyart GH, Sackett DL, et al. Users’guides to the medical literature. III. How to use an artical about a diagnostic test.B. What are the results and will they help me in caring for mypatients? The Evidence-Based Medicine Working Group. JAMA,1994, 271: 703-707.
15. Salaun PY, Couturaud F, Le DA, et al. Noninvasive diagnosis of pulmonary embolism. Chest, 2011 , 139: 1294 -1298 .
16. Safriel Y, Zinn H. CT pulmonary angiography in the detection of pulmonary emboli: a meta-analysis of sensitivities and specificities.Clin Imaging, 2002, 26: 101-105.
17. 郭佑民, 張少娟, 楊健, 等. CT 動脈造影對肺動脈栓塞診斷價值的Meta 分析. 中華放射學雜志, 2004 , 38: 706-710.
18. Moses LE, Shapiro D, Littenberg B. Combining independent studies of a diagnostic test into a summary ROC curve: data-analytic approaches and some additional considerations. Stat Med, 1993, 12 :1293-1316.
19. patients. Clin Imaging, 2006, 30 : 166-172.
20. .

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磁共振肺動脈造影對肺動脈栓塞診斷價值的Meta 分析

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磁共振肺動脈造影對肺動脈栓塞診斷價值的Meta 分析

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