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目的:采用Meta分析法比较CT脑血流灌注(computer tomography perfusion,CTP)与CT血管造影(computer tomography angiography,CTA)在蛛网膜下腔出血(subarachnoid hemorrhage,SAH)后脑血管痉挛(cerebral vasospasm,CVS)的诊断价值。方法:以Sino Med、中国期刊网、维普数据库等为国内文献的主要来源;Cochrane图书馆、Medline数据库及Ovid数据库、Elsevier和Springer数据库等作为国外文献的主要来源。发表年限为1999年至2014年。按照Cochran协作网推荐的诊断试验纳入标准选取文献,并提取纳入研究的诊断信息。统计分析采用Rev Man 5.0软件,并同时考察纳入文献间的异质性,再根据异质性结果选择相应的效应模型。对所纳入的研究予以加权定量合并,得出合并效应量,计算其95%可信区间,并对合并效应量进行假设检验。结果:按照纳入标准共获取文献6篇,其中有关CTP的3篇(多层螺旋CT),CTA为4篇,均有金标准DSA比较;前瞻性研究2篇,回顾性研究4篇。各组研究均不存在异质性,按照固定效应模型对纳入文献行汇总分析。结果显示,对于蛛网膜出血后脑血管痉挛、CTP诊断的合并效应量估计值为1.59,95%可信区间为0.94-2.69;CTA合并效应量估计值为1.45,95%可信区间为1.18-1.77。结论:对于蛛网膜下腔出血后脑血管痉挛,CTP诊断的准确性高于CTA诊断。
OBJECTIVE: To compare the clinical significance of cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH) by CT scan of computer tomography perfusion (CTP) and CT angiography (CTA) ) Diagnostic value. Methods: The main sources of domestic literature were Sino Med, China Journal Net and VIP database. The Cochrane Library, Medline Database, Ovid Database, Elsevier and Springer Database were the main sources of foreign literature. The publication period is from 1999 to 2014. Follow the recommended diagnostic tests in the Cochran Collaboration for inclusion criteria and extract diagnostic information for inclusion in the study. Statistical analysis using Rev Man 5.0 software, and at the same time examine the heterogeneity of included literature, and then select the appropriate effect model based on heterogeneity results. The included studies were weighted quantitatively combined to obtain the amount of combined effects, calculated 95% confidence interval, and the amount of combined effects of hypothesis testing. Results: According to the inclusion criteria, a total of 6 articles were obtained, of which 3 articles on CTP (multi-slice spiral CT) and 4 articles on CTA were gold standard DSA; 2 were prospective and 4 were retrospectively studied. There was no heterogeneity in all the groups, and the data were analyzed by fixed effects model. The results showed that for cerebral vasospasm after arachnoid hemorrhage, the combined effect of CTP diagnosis was estimated to be 1.59, the 95% confidence interval was 0.94 to 2.69, the CTA combined effect was estimated to be 1.45, and the 95% confidence interval was 1.18 to 1.77 . Conclusion: The accuracy of CTP in the diagnosis of cerebral vasospasm after subarachnoid hemorrhage is higher than that of CTA.