经颅黑质超声对帕金森病诊断价值的系统评价和Meta分析

Diagnostic value of transcranial sonography on substantia nigra in Parkinson disease: a systematic review and Meta-analysis

摘要:

目的： 基于Meta分析方法，系统评价经颅黑质超声检查（transcranial sonography，TCS）对帕金森病（Parkinson disease，PD）的诊断价值。方法： 计算机检索PubMed、Embase、Cochrane图书馆及中国期刊全文数据库（CNKI）、中国科技期刊全文数据库（VIP）、中国生物医学文献数据库（CBM）中公开发表的文献，收集近十年有关TCS诊断PD的中英文文献，检索时限自2010年1月至2019年11月。由2名评价员根据纳入与排除标准，独立筛选文献、评价文献质量并提取相关资料。采用Meta-DiSc1.4软件进行Meta分析，根据异质性结果选择相应效应模型，汇总效应量及其95%CI，绘制受试者工作特征（receiver operator characteristic，ROC）曲线，并计算曲线下面积（area under the curve，AUC）及Q指数。最后应用Stata 12.0软件绘制Deek's漏斗图评估发表偏倚。结果： 共检索到相关文献753篇，严格按照纳入与排除标准筛选后，最终纳入28篇研究文献。Meta分析结果显示：TCS诊断PD的合并敏感度=0.82（95%CI=0.80~0.83）；合并特异度=0.90（95%CI=0.88~0.91）；合并诊断比值比=42.84（95%CI=28.37~64.68）；合并阳性似然比=7.46（95%CI=6.11~9.11）；合并阴性似然比=0.19（95%CI=0.15~0.25；SROC AUC为0.947 0；Q指数为0.886 5。结论： 作为一种新型的神经疾病辅助检查方法，TCS在PD的诊断上展现出较高的诊断价值，且该技术兼具有无创、无辐射、经济、易操作等优点，故可将其作为PD早期筛查及辅助诊断工具推广应用。

Abstract:

Objective: To assess the efficacy of transcranial sonography (TCS) on substantia nigra in Parkinson disease (PD) on the basis of Meta analysis. Methods: Studies about TCS from January 2010 to November 2019 in databases of PubMed, Embase, Cochrane library, CNKI, VIP and CBM were searched and collected. Two evaluators independently screened the literature, evaluated the quality of the literature and extracted relevant information according to inclusion and exclusion criteria. Meta-DiSc1.4 software was used to perform the Meta analysis, corresponding effect model was selected according to the heterogeneity results, effect size and 95% confidence interval (95%CI) were calculated, the receiver operator characteristic (ROC) curve was drawn, area under the curve (AUC) as well as Q value was calculated and Deek's funnel plot was drawn by adopting Stata 12.0 software to evaluate and publish bias. Results: A total of 753 literatures were retrieved and 28 literatures were finally included. Meta analysis results showed that the combined sensitivity of TCS in diagnosing PD was 0.82 (95%CI=0.80-0.83), the combined specificity was 0.90 (95%CI=0.88-0.91), the diagnostic odds ratio was 42.84 (95%CI=28.37-64.68), the positive likelihood radio was 7.46 (95%CI=6.11-9.11), the negative likelihood radio was 0.19 (95%CI=0.15-0.25), and SROC AUC and Q index were 0.947 0 and 0.886 5, respectively. Conclusion: As a new auxiliary examination method for neurological diseases, TCS has a high diagnostic value in the diagnosis of PD, non-invasive, radiation-free, economical and easy to operate, which can be promoted in the clinical as an early screening and auxiliary diagnostic tool for PD.