中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2012年
3期
132-139
,共8页
黄胜%黄托夫%娄普%潘秋飞%陈翔
黃勝%黃託伕%婁普%潘鞦飛%陳翔
황성%황탁부%루보%반추비%진상
脑性瘫痪%婴儿%早产%磁共振成像%Meta分析
腦性癱瘓%嬰兒%早產%磁共振成像%Meta分析
뇌성탄탄%영인%조산%자공진성상%Meta분석
Cerebral palsy%Infant,premature%Magnetic resonance imaging%Meta-analysis
目的 通过meta分析定量评价早产儿生后早期头颅磁共振成像结果预测远期发生脑性瘫痪的临床价值. 方法 计算机检索PubMed、Embase、Cochrane、中国生物医学文献数据库、中国期刊全文数据库、维普数据库和万方数据库中关于早产儿头颅磁共振成像结果预测脑性瘫痪的相关文献.纳入标准:(1)研究目的为评价早产儿生后早期头颅磁共振成像结果预测远期神经预后的价值；(2)研究类型为前瞻性的队列研究与随机对照试验以及回顾性的病例分析与病例对照研究；(3)头颅磁共振成像的检查时间窗为小于纠正年龄3个月；(4)脑性瘫痪诊断金标准为随访结果,且诊断标准明确.采用Stata11.0统计软件进行meta分析,计算敏感性、特异性、阳性和阴性似然比.结果 共纳入7篇英文文献,772例早产儿,发生脑性瘫痪92例.早产儿生后早期头颅磁共振成像结果预测远期发生脑性瘫痪的合并敏感性为0.93(95％CI:0.65～0.99),特异性为0.89(95％CI:0.81～0.93),阳性似然比为8.19(95％CI:4.48～14.94),阴性似然比为0.08(95％CI:0.01～0.52),总受试者工作特性曲线下面积为0.95(95％CI:0.92～0.96).合并值存在明显异质性,差异有统计学意义(P＜0.05).排除1篇回顾性研究与1篇低发病率文献后异质性显著降低(P＞0.10),预测精确性相应有所降低,合并敏感性为0.81(95％CI:0.58～0.93),特异性为0.82 (95％ CI:0.76～0.87). 结论 早产儿生后早期头颅磁共振成像结果预测远期脑性瘫痪的发生可能具有较高的精确性,尤其是对阴性结果,排除价值较高.而对于具有高危因素的早产儿,头颅磁共振成像的阳性结果,预测效率可能更高.
目的 通過meta分析定量評價早產兒生後早期頭顱磁共振成像結果預測遠期髮生腦性癱瘓的臨床價值. 方法 計算機檢索PubMed、Embase、Cochrane、中國生物醫學文獻數據庫、中國期刊全文數據庫、維普數據庫和萬方數據庫中關于早產兒頭顱磁共振成像結果預測腦性癱瘓的相關文獻.納入標準:(1)研究目的為評價早產兒生後早期頭顱磁共振成像結果預測遠期神經預後的價值；(2)研究類型為前瞻性的隊列研究與隨機對照試驗以及迴顧性的病例分析與病例對照研究；(3)頭顱磁共振成像的檢查時間窗為小于糾正年齡3箇月；(4)腦性癱瘓診斷金標準為隨訪結果,且診斷標準明確.採用Stata11.0統計軟件進行meta分析,計算敏感性、特異性、暘性和陰性似然比.結果 共納入7篇英文文獻,772例早產兒,髮生腦性癱瘓92例.早產兒生後早期頭顱磁共振成像結果預測遠期髮生腦性癱瘓的閤併敏感性為0.93(95％CI:0.65～0.99),特異性為0.89(95％CI:0.81～0.93),暘性似然比為8.19(95％CI:4.48～14.94),陰性似然比為0.08(95％CI:0.01～0.52),總受試者工作特性麯線下麵積為0.95(95％CI:0.92～0.96).閤併值存在明顯異質性,差異有統計學意義(P＜0.05).排除1篇迴顧性研究與1篇低髮病率文獻後異質性顯著降低(P＞0.10),預測精確性相應有所降低,閤併敏感性為0.81(95％CI:0.58～0.93),特異性為0.82 (95％ CI:0.76～0.87). 結論 早產兒生後早期頭顱磁共振成像結果預測遠期腦性癱瘓的髮生可能具有較高的精確性,尤其是對陰性結果,排除價值較高.而對于具有高危因素的早產兒,頭顱磁共振成像的暘性結果,預測效率可能更高.
목적 통과meta분석정량평개조산인생후조기두로자공진성상결과예측원기발생뇌성탄탄적림상개치. 방법 계산궤검색PubMed、Embase、Cochrane、중국생물의학문헌수거고、중국기간전문수거고、유보수거고화만방수거고중관우조산인두로자공진성상결과예측뇌성탄탄적상관문헌.납입표준:(1)연구목적위평개조산인생후조기두로자공진성상결과예측원기신경예후적개치；(2)연구류형위전첨성적대렬연구여수궤대조시험이급회고성적병례분석여병례대조연구；(3)두로자공진성상적검사시간창위소우규정년령3개월；(4)뇌성탄탄진단금표준위수방결과,차진단표준명학.채용Stata11.0통계연건진행meta분석,계산민감성、특이성、양성화음성사연비.결과 공납입7편영문문헌,772례조산인,발생뇌성탄탄92례.조산인생후조기두로자공진성상결과예측원기발생뇌성탄탄적합병민감성위0.93(95％CI:0.65～0.99),특이성위0.89(95％CI:0.81～0.93),양성사연비위8.19(95％CI:4.48～14.94),음성사연비위0.08(95％CI:0.01～0.52),총수시자공작특성곡선하면적위0.95(95％CI:0.92～0.96).합병치존재명현이질성,차이유통계학의의(P＜0.05).배제1편회고성연구여1편저발병솔문헌후이질성현저강저(P＞0.10),예측정학성상응유소강저,합병민감성위0.81(95％CI:0.58～0.93),특이성위0.82 (95％ CI:0.76～0.87). 결론 조산인생후조기두로자공진성상결과예측원기뇌성탄탄적발생가능구유교고적정학성,우기시대음성결과,배제개치교고.이대우구유고위인소적조산인,두로자공진성상적양성결과,예측효솔가능경고.
Objective To evaluate the value of early brain magnetic resonance imaging (MRI) in predicting future cerebral palsy in premature infants. Methods Searching the related literatures in PubMed,Embase,Cochrane,China Biological Medical Literature Database,China Academic Journal Full-Text Database,VIP Database and Wanfang Database.Inclusion criteria:(1) the purpose of the research was to evaluate the value of early brain MRI in predicting cerebral palsy of premature infants;(2) the type of research was prospective cohort study,randomized controlled trial,retrospective case analysis or case control studies; (3) the inspection was taken within 3 months of correction age; (4)the gold standard in diagnosing cerebral palsy was based on follow-up results,and the diagnosis criteria was clear.The sensitivity,specificity,positive and negative likelihood ratio were calculated and pooled by Stata11.0. Results Seven studies were enrolled into this meta-analysis including 772 premature infants and among which 92 were diagnosed as cerebral palsy.The pooled sensitivity was 0.93 (95％CI:0.65-0.99),specificity was 0.89 (95％CI:0.81-0.93),positive likelihood ratio was 8.19 (95％CI:4.48-14.94) and the negative likelihood ratio was 0.08 (95％CI:0.01-0.52),the area under the summary receiver operating characteristic curve was 0.95 (95％ CI:0.92-0.96).Significant heterogeneity was found (P＜0.05).When one retrospective study and one low morbidity study was removed,heterogeneity reduced significantly (P＞0.10),and predictive accuracy slightly decreased.The pooled sensitivity was 0.81 (95％CI:0.58-0.93 ),specificity was 0.82 (95％CI:0.76-0.87). Conclusions Early brain MRI has high accuracy in predicting future cerebral palsy of premature infant,especially for negative results.And for the premature infants with high risk factors,positive brain MRI result might have a higher predictive efficiency.
