超声横截面积法对腕管综合征诊断价值的meta分析

发布时间：2018-03-18 01:10

本文选题：腕管综合征　切入点：正中神经横截面积　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的:腕管综合征是周围神经卡压性疾病最常见的一种,手指麻木及腕部肿胀是其主要症状,早期诊断常可采用保守治疗,预后良好,如不及时治疗可能会造成神经永久损伤,并且极大的影响工作与生活。目前腕管综合征的诊断主要依靠病史、临床表现与神经电生理检查,电生理检查被认为是腕管综合征的诊断金标准,但是电生理检查只能评价正中神经的功能受损程度,不能为临床提供有助于发现病因和确定手术方式的相关解剖学的信息,所以影像学检查是必要的补充。虽然MRI具有良好的软组织分辨能力,但因为费用高昂、耗时长等原因并没有被广泛应用。近年来随着诊断技术的发展,超声在肌骨领域的应用越来越广泛,高频超声也逐渐作为腕管综合征的非侵入性的可行诊断方法,许多学者对此进行了相关研究,涉及的指标有正中神经横截面积、膨胀率、扁平率等,研究最多的是正中神经横截面积,然而报道的诊断准确性有所不同。本论文运用循证医学的研究方法,通过对已发表的超声诊断腕管综合征临床试验的相关数据进行汇总分析,评价超声测量正中神经横截面积对腕管综合征的诊断价值。研究方法:将“腕管综合征”、“超声”、“carpal tunnel syndrome”、“ultrasonography”(或“sonography”、“ultrasound”等)为检索词,通过主题词、关键词检索从1990年以来至2016年12月的Pubmed、medline、Cochrane图书馆、中国知网、万方数据库等数据库收录的文献,根据已制定的纳入标准和排除标准,对符合要求的文献依据QUADAS作为标准进行质量评价,直接或间接提取出纳入研究的特征信息以及真阳性值、假阳性值、真阴性值、假阴性值以及研究的背景和方法学信息。使用stata12.0软件,运用双变量随机效应模型,利用经典Q统计量进行异质性检验,并计算出I2值,如若异质性较大,则进行meta回归分析及亚组分析探索异质性来源,随后进行meta分析,汇总合并敏感度、特异度、阴性似然比、阳性似然比、诊断优势比及其95%可信区间等,绘制SROC曲线并计算曲线下面积,绘制漏斗图分析文献发表偏倚。研究结果:经过检索筛选最终一共纳入19篇文章,其中英文16篇,中文3篇,病例组1575例研究对象(手腕数),对照组1065例研究对象(手腕数),共计2640例,进行异质性检验得出p=0.000,I2=95(95%CI 92-99),提示异质性较高,meta回归及亚组分析提示,对照组是健康人群手腕还是患病人群的健康手腕、正中神经测量平面、测量方法、是否使用盲法、病例数、探头频率等均可能是异质性来源。运用双变量效应模型汇总得到的敏感度为0.88(95%CI 0.83-0.91),特异度为0.88(95%CI0.81-0.93),阳性似然比为7.6(95%CI4.6-12.3),阴性似然比为0.14(95%CI 0.10-0.19),诊断优势比为43.66(95%CI25.26-75.47)。绘制SROC曲线,曲线下面积AUC=0.93(95%CI0.91-0.95),说明该诊断试验良好。漏斗图分析显示纳入文献可能存在发表偏倚。最终结论:Meta分析提示,超声测量正中神经横截面积诊断腕管综合征,敏感度和特异度均较高,既经济、方便、无创,还能提供相关的解剖信息,作为电生理检查的有效补充,具备一定的诊断价值和较高的临床实用价值。然而目前尚缺乏统一的超声诊断标准,许多混杂因素如研究对象选择、测量方法等都会影响诊断结果,还需要大规模的、设计严谨的诊断试验以进一步探讨和明确其诊断价值和诊断标准,并制定腕管综合征的超声诊断标准。
[Abstract]:Objective: To study the carpal tunnel syndrome is a kind of peripheral nerve compression of the most common diseases, the main symptoms are numbness in the fingers and wrist swelling, early diagnosis can often be treated conservatively, the prognosis is good, if not timely treatment may cause permanent damage to the nervous, and greatly affect the work and life. The diagnosis of wrist tube syndrome mainly depends on medical history, clinical manifestation and electrophysiological examination, electrophysiological examination is considered to be the gold standard for the diagnosis of carpal tunnel syndrome, but the electrophysiological examination can evaluate the median nerve function damage degree, not for clinical provide help to find the cause and determine the relevant anatomical surgical information. So the imaging examination is a necessary supplement. Although MRI has a good soft tissue resolution, but because of the high cost, and no time-consuming reason is widely used. In recent years with the diagnosis technology The development of ultrasound applied in musculoskeletal fields widely, high frequency ultrasound has gradually as a feasible non invasive diagnostic methods of carpal tunnel syndrome, many scholars have carried out relevant research, these indicators are the median nerve cross-sectional area, expansion rate, flat rate, research the most is the median nerve cross the cross-sectional area, however the diagnostic accuracy reported is different. This paper uses the research method of evidence-based medicine, analyze the ultrasound data published tube syndrome clinical trial, to evaluate the diagnostic value of ultrasonic measurement of median nerve cross-sectional area of carpal tunnel syndrome. Methods: "carpal tunnel syndrome", "ultrasound", "carpal tunnel syndrome", "ultrasonography" (or "sonography", "ultrasound") as the search term, through keywords, keyword retrieval from 1990 to 2016 In December, Pubmed, MEDLINE, Cochrane library, China CNKI, Wanfang database database included literature according to the inclusion and exclusion criteria, to meet the requirements of the literature on the basis of QUADAS as a standard to evaluate the quality, directly or indirectly, to extract the feature information into the research and the value of true positive, false positive value, really the negative value of information, false negative value as well as the research background and methods. The use of stata12.0 software, using a bivariate random effects model to test for heterogeneity by using the classical Q statistics, and calculate the I2 value, such as if the heterogeneity, then meta regression and subgroup analysis to explore the sources of heterogeneity, followed by meta analysis of consolidation of sensitivity, specificity, negative likelihood ratio, positive likelihood ratio, diagnostic odds ratio and 95% confidence interval, SROC curve and calculate the area under the curve analysis, funnel plot The publication bias. Results: after screening a total of 19 final retrieval articles, including English 16, Chinese 3, a total of 1575 cases of object (wrist number), 1065 cases in the control group (the research object, a total of 2640 cases of wrist number), heterogeneity test showed p= 0 (95%CI 92-99, I2=95), suggesting higher heterogeneity, meta regression and subgroup analysis showed that the control group is healthy or sick people health wrist wrist median nerve measuring plane, measuring method, the use of blinding, the number of cases, probe frequency can be sources of heterogeneity. Using the double variable effect model get a summary of sensitivity 0.88 (95%CI 0.83-0.91), the specificity was 0.88 (95%CI0.81-0.93), the positive likelihood ratio was 7.6 (95%CI4.6-12.3), negative likelihood ratio was 0.14 (95%CI 0.10-0.19), diagnostic odds ratio was 43.66 (95%CI25.26-75.47). The SROC curve, the area under the curve AUC= 0.93 (95%CI0.91-0.95), indicating that the diagnostic test is good. The funnel plot analysis showed that included the potential publication bias. Conclusion: Meta analysis showed that the median nerve cross-sectional area measured by ultrasound in diagnosis of carpal tunnel syndrome, high sensitivity and specificity, economical, convenient, non-invasive, can provide anatomical information related to as an effective complement, electrophysiological examination, have high diagnostic value and certain clinical value. However, there is still a lack of unified diagnostic standard, many confounding factors such as research object, measurement method will affect the diagnosis results, also need large-scale, rigorous design of diagnostic tests to further explore and clear the diagnostic value and diagnostic criteria, and formulate the ultrasonic diagnostic criteria of carpal tunnel syndrome.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R688

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