摘要
目的探讨多普勒超声扫描、磁共振血管造影和 CT 血管造影单独或联合应用在评估下肢动脉疾病中的诊断准确性;评价这些检查方法对患者治疗和结果的影响;评价患者对这些检查方法的态度并总结与不良事件相关的现有资料。设计系统性综述。方法检索11个电子数据库(截至2005年4月)、6本杂志和已找到文献中的参考文献以发现相关研究。两名评审员独立选择研究、提取资料和评估质量。使用 QUADASQ 目录评估诊断准确性研究的质量。结果 107项研究符合入选标准;其中,58项研究提供关于诊断准确性的资料,1项关于患者结果,4项关于患者态度和44项关于不良事件。质量评估强调研究报告的方法及质量的不足。由于大多数入选研究根据动脉节段而不是整条肢体或患者来报告结果,这样就不能解释患者多节段病变,所以可能高估检查的特异度。对发现下肢动脉50%及以上狭窄,造影剂增强磁共振血管造影诊断准确性最高,敏感度中位数95%(92%～99.5%)和特异度中位数97%(64%～99%);CT 血管造影分别为91%(89%～99%)和91%(83%～97%);多普勒超声扫描为88%(80%～98%)和96%(89%～99%)。一项对照试验报告,尽管基于单一的多普勒超声扫描或传统血管造影患者的治疗结果无明显差异,但是22%的患者需要另行血管造影以制定治疗方案。现有的证据表明:相对于传统血管造影,患者更愿意选择磁共振血管造影(有或无造影剂增强),而在磁共振血管造影无禁忌(如患有幽居恐怖症)的患者中,半数对磁共振血管造影或多普勒超声扫描无偏好。在现有关于不良事件的资料中,磁共振血管造影发生不良事件的比例最高,但是症状轻微。最严重的不良事件,尽管少见,但主要发生于传统血管造影中。结论造影剂增强磁共振血管造影较 CT 血管造影特异性更高(排除50%以上狭窄病变的准确性更高),较多普勒超声扫描敏
Objectives To determine the diagnostic accuracy of duplex ultrasonography, magnetic resonance angiography, and computed tomography angiography, alone or in combination, for the assessment of lower limb peripheral arterial disease; to evaluate the impact of these assessment methods on management of patients and outcomes; and to evaluate the evidence regarding attitudes of patients to these technologies and summarise available data on adverse events.
Design Systematic review.
Methods Searches of 11 electronic databases （to April 2005）, six journals, and reference lists of included papers for relevant studies. Two reviewers independently selected studies, extracted data, and assessed quality. Diagnostic accuracy studies were assessed for quality with the QUADAS checklist.
Results 107 studies met the inclusion criteria; 58 studies provided data on diagnostic accuracy, one on outcomes in patients, four on attitudes of patients, and 44 on adverse events. Quality assessment highlighted limitations in the methods and quality of reporting. Most of the included studies reported results by arterial segment, rather than by limb or by patient, which does not account for the clustering of segments within patients, so specificities may be overstated. For the detection of stenosis of 50% or more in a lower limb vessel, contrast enhanced magnetic resonance angiography had the highest diagnostic accuracy with a median sensitivity of 95% （range 92-99.5% ） and median specificity of 97% （64-99%）. The results were 91% （89-99%） and 91% （83-97%） for computed tomography angiography and 88% （80-98%） and 96% （89-99%） for duplex ultrasonography. A controlled trial reported no significant differences in outcomes in patients after treatment plans based on duplex ultrasonography alone or conventional contrast angiography alone, though in 22% of patients supplementary contrast angiography was needed to form a treatment plan. The limited evidence available suggested that patients preferred magnetic resonance
出处
《英国医学杂志中文版》
2007年第6期344-348,共5页
The BMJ Chinese Edition
基金
Health Technology Assessment Programme(project No 03/07/04)The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the Department of Health
