三种MRI标准对首发的儿童多发性硬化诊断价值的Meta分析

发布时间：2018-05-26 01:15

本文选题：头颅磁共振 + 多发性硬化　；参考：《遵义医学院》2017年硕士论文

【摘要】：目的:系统评价三种头颅MRI标准(KIDMUS标准、Callen诊断MS标准和Callen MS与ADEM的鉴别标准)对首次发生的儿童多发性硬化(MS)的诊断价值。方法:计算机检索Pub Med、CENTRAL、EMbase、CNKI、VIP、万方数据库中有关国内外三种头颅MRI标准对儿童MS的诊断性试验,检索时限均为从建库至2016年6月30日。由两位研究者独立筛选文献、提取数据和评价纳入研究的方法学质量后,采用Meta-Disc 1.4软件进行Meta分析。分别计算合并敏感度(SEN)、特异度(SPE)、阳性似然比(+LR)、阴性似然比( LR)、诊断比值比(DOR)及综合受试者工作特征曲线(SROC)下面积(AUC)。结果:初检出426篇文献,最终纳入7篇,共计660例患者。Meta分析结果显示:对于KIDMUS MS诊断标准、Callen诊断MS标准和Callen MS与ADEM的鉴别标准,Spearman相关系数分别为0.714、0.714和-0.10,相对应的P值分别为0.111、0.071和0.873,提示均不存在阈值效应。结果显示:1)KIDMUS MS诊断标准的SEN合并=0.40[95%CI(0.33,0.47)]、SPE合并=0.98[95%CI(0.96,0.99)]、+LR合并=11.36[95%CI(6.39,20.20)]、 LR合并=0.67[95%CI(0.52,0.87)]、DOR合并=20.76[95%CI(10.78,39.95)],AUC=0.92。2)Callen诊断MS标准的SEN合并=0.80[95%CI(0.73,0.86)]、SPE合并=0.90[95%CI(0.86,0.93)]、+LR合并=7.7[95%CI(4.79,12.39)]、 LR合并=0.24[95%CI(0.11,0.55)]、DOR合并=38.77[95%CI(11.07,135.75)],AUC=0.96。3)Callen的鉴别MS与ADEM标准的SEN合并=0.80[95%CI(0.73,0.86)]、SPE合并=0.90[95%CI(0.86,0.93)]、+LR合并=7.7[95%CI(4.79,12.39)]、 LR合并=0.24[95%CI(0.11,0.55)]、DOR合并=38.77[95%CI(11.07,135.75)],AUC=0.96。结论:本文证据显示,KIDMUS标准和Callen的鉴别MS与ADEM标准对首发的儿童MS诊断价值较高,而Callen诊断MS标准的诊断价值中等。但受纳入研究质量、未能纳入所有疑似患者和病例数量的限制,上述结论尚需开展更多高质量诊断性研究加以验证。
[Abstract]:Objective: to evaluate the diagnostic value of three cranial MRI criteria (KIDMUS, Callen, Callen MS and ADEM) in the first occurrence of multiple sclerosis in children. Methods: a computerized search was conducted for the diagnosis of MS in children by Pub Medtral MRI standards in Wanfang database. The searching time was from the establishment of the database to June 30, 2016. Two researchers independently sifted the literature, extracted the data and evaluated the methodological quality of the study, and then analyzed Meta with Meta-Disc 1.4 software. The area under the combined sensitivity, specificity, positive likelihood ratio (LRN), negative likelihood ratio (LRN), diagnostic ratio (Dor) and SROC curve were calculated respectively. Results: 426 articles were first detected and 7 articles were included. The results of Meta-analysis showed that the correlation coefficients of KIDMUS MS and Callen MS were 0.714 卤0.714 and -0.10, respectively. The corresponding P values were 0.111 ~ 0.071 and 0.873, respectively, indicating that there was no threshold effect. 缁撴灉鏄剧ず:1)KIDMUS MS璇婃柇鏍囧噯鐨凷EN鍚堝苟=0.40[95%CI(0.33,0.47)],SPE鍚堝苟=0.98[95%CI(0.96,0.99)], LR鍚堝苟=11.36[95%CI(6.39,20.20)], LR鍚堝苟=0.67[95%CI(0.52,0.87)],DOR鍚堝苟=20.76[95%CI(10.78,39.95)],AUC=0.92.2)Callen璇婃柇MS鏍囧噯鐨凷EN鍚堝苟=0.80[95%CI(0.73,0.86)],SPE鍚堝苟=0.90[95%CI(0.86,0.93)], LR鍚堝苟=7.7[95%CI(4.79,12.39)], LR鍚堝苟=0.24[95%CI(0.11,0.55)],DOR鍚堝苟=38.77[95%CI(11.07,135.75)],AUC=0.96.3)Callen鐨勯壌鍒玀S涓嶢DEM鏍囧噯鐨凷EN鍚堝苟=0.80[95%CI(0.73,0.86)],SPE鍚堝苟=0.90[95%CI(0.86,0.93)], LR The DOR merger is 38.77 [95 CI 11.07135.75]. Conclusion: the evidence in this paper shows that the differential MS and ADEM criteria of KIDMUS and Callen are of high value in the diagnosis of first-episode MS in children, while the diagnostic value of Callen in diagnosing MS is moderate. However, these conclusions need to be verified by more high quality diagnostic studies, which are limited by the quality of the study and the number of suspected patients and cases.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R744.51

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