睡眠内镜对OSAHS阻塞平面定位诊断的系统评价和Meta分析

发布时间：2018-07-15 15:43

【摘要】：目的系统评价诱导睡眠状态下电子鼻咽喉镜(DISE)检查对于OSAHS成人患者上气道多平面阻塞诊断的临床价值。方法按照Cochrane系统评价的方法,检索MEDLINE(PubMed)、EMBASE、CCTR(The Cochrane Controlled Clinical Trials Register Database)、中国知网、万方数据库等。检索国内外发表的截止2016年1月关于睡眠内镜在OSAHS定位诊断中的临床应用价值的研究,通过纳入和排除标准筛选出采用睡眠内镜对OSAHS阻塞平面定位诊断的队列研究。首先应用诊断试验质量评价工具QUADAS-2评价纳入文献的质量,然后使用分析软件Meta-Disc1.4对提取的数据进行统计学分析。结果最终纳入定性研究的文献7篇,纳入定量分析的文献3篇,○1纳入的研究QUADAS-2质量评价结果:病例选择方面,发生偏倚风险的可能性大,适用性评价均为“是”;待评价试验方面,偏倚风险评价“不清楚”的50%,临床适用性评价“是”的60%;金标准方面提示偏倚风险可能性较大,临床适用性较高;病例流程和进展情况方面偏倚风险评价“是”的90%。○2纳入定量分析的研究试验3个,共175例患者,所有研究均为临床自身对照试验,统计学分析显示不存在阈值效应,纳入定量分析的研究间异质性较小,合并敏感度、特异度及95%CI分别为1.0(0.96~1.0)、0.71(0.59~0.81),合并诊断比值比为212.47(36.07~1251.56),合并阳性似然比(㧏LR)、合并阴性似然比( LR)分别为4.40(1.28~15.16)、0.02(0~0.11),纳入研究的SROC曲线下面积(AUC)为0.9910。○3纳入定性分析的研究7个,有2篇研究采用的咪唑安定诱导患者进入睡眠状态,其余5篇研究均采用异丙酚诱导患者进入睡眠状态,4篇文献提到睡眠内镜和清醒内镜两种定位诊断方法结果提示在腭后区和舌根平面的两个平面阻塞程度明显不一致。结论纳入研究统计学分析的结果提示睡眠内镜对OSAHS患者上气道多平面阻塞的诊断敏感性高,可以作为OSAHS诊断重要的辅助检查,为手术方式的选择和预后的判断提供参考。但是纳入的文献数量有限,还需要更多大样本的质量高的队列研究试验来进一步的检验。
[Abstract]:Objective to evaluate the clinical value of electronic nasopharyngeal laryngoscope (DISE) in the diagnosis of upper airway multiplanar obstruction in adult patients with OSAHS. Methods according to the method of Cochrane systematic review, MEDLINE (PubMed) EMBASE CCTR (the Cochrane controlled Clinical Trials Register Database), CCTR (the Cochrane controlled Clinical Trials Register), CCTR, Wanfang database, etc. A cohort study on the clinical application of sleep endoscopy in the diagnosis of OSAHS occlusion plane by inclusion and exclusion of the criteria was retrieved and published at home and abroad until January 2016, and a cohort study on the diagnosis of OSAHS occlusion plane using sleep endoscopy was selected. First, QUADAS-2 was used to evaluate the quality of the literature, and then the extracted data were statistically analyzed by Meta-Disc 1.4. Results 7 papers were included in qualitative research and 3 articles in quantitative analysis were included in QUADAS-2. The results showed that the risk of bias was high in case selection, and the applicability evaluation was "yes". In the trial to be evaluated, 50 of bias risk evaluation "unclear", 60 of clinical applicability evaluation "yes", the gold standard indicates that bias risk is more likely and clinical applicability is higher; Risk assessment of bias in case flow and progression "Yes" 90.02 was included in the quantitative analysis of three patients in 175 patients, all of whom were clinical self-controlled trials, and statistical analysis showed that there was no threshold effect. Among the quantitative analysis, the heterogeneity was small and the sensitivity was low. The specificity and 95 CI were 1.0 (0.961.0) 0.71 (0.590.81), the ratio of combined diagnosis was 212.47 (36.07) 1251.56, the combined positive likelihood ratio (lrr) and the combined negative likelihood ratio (LLR) were 4.40 (1.2815.16) 0.02 (00.11), respectively. The area under the SROC curve (AUC) was 0.9910.03. In two studies, midazolam was used to induce patients to sleep. The other five studies all used propofol to induce patients to sleep. 4 articles mentioned that the two localization methods of sleep endoscopy and awake endoscopy showed that the degree of obstruction in the posterior palatal region and the tongue root plane was significantly different. Conclusion the results of statistical analysis indicate that sleep endoscopy is highly sensitive to the diagnosis of upper airway multiplanar obstruction in OSAHS patients. It can be used as an important auxiliary examination in the diagnosis of OSAHS and provide reference for the choice of surgical methods and the judgment of prognosis. However, there is a limited amount of literature included, and more high-quality cohort trials of large samples are needed for further testing.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R766

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