中国口腔颌面外科杂志

中国口腔颌面外科杂志 ›› 2014, Vol. 12 ›› Issue (3): 266-272.

• 循证医学 • 上一篇    下一篇

应用HSROC统计模型对高分辨率超声诊断颞下颌关节盘前移位准确性的meta分析

董小宇1,朱祖凤1,2,张新丽1,何帅2   

  1. 1.温州医科大学 口腔医学院,浙江 温州 325000; 2.解放军第118医院 口腔科,浙江 温州 325000
  • 收稿日期:2013-06-03 出版日期:2014-05-10 发布日期:2014-07-15
  • 通讯作者: 何帅,E-mail:capitall@163.com E-mail:383906397@qq.com
  • 作者简介:董小宇(1988-),男,硕士研究生
  • 基金资助:
    全军医学科学技术研究“十一五”计划面上项目(06MA151);南京军区卫生专业人才“122工程”学科带头人培养计划(卫综20080987);南京军区医疗科研“十一五”创新计划基金项目(Y07010);南京军区医疗科研“十二五”重点专项基金项目(11Z007)

The diagnostic value of high-resolution ultrasonography for detecting of anterior disc displacement of temporomandibular joint: a meta-analysis by HSROC statistical model

DONG Xiao-yu1, ZHU Zu-feng1,2, ZHANG Xin-li1, HE Shuai2   

  1. 1.School and Hospital of Stomatology, Wenzhou Medical College. Wenzhou 325000; 2.Department of Stomatology, NO.118 Hospital of Nanjing Military Command, PLA. Wenzhou 325000, Zhejiang Province, China
  • Received:2013-06-03 Online:2014-05-10 Published:2014-07-15

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摘要： 目的:评价高分辨率超声(HR-US)对颞下颌关节盘前移位(anterior disc displacement,ADD)的诊断价值。方法:计算机检索PubMed(1966～2013.9)、CNKI(1994～2013.9)、CBM(1978～2013.9)、Embase(1974～2013.9)、VIP(1994～2013.9)数据库,辅助手工检索及其他检索,查找关于高分辨率超声用于诊断ADD的文献。由2名评价者按照QUADAS(quality assessment of diagnostic accuracy studies)质量评价标准评价纳入研究的质量,进行资料提取,交叉核对,采用分层综合受试者操作特征曲线(HSROC)分析模型进行meta分析,根据贝叶斯理论Fagan’s Nomogram统计评价该方法的临床应用价值,利用Stata12.0软件包对纳入数据进行分析。结果:共纳入研究12篇,1137例受试者。Meta分析结果显示,HR-US诊断可复性盘前移位(ADDWR)的合并Sen=0.84(95%CI=0.76～0.90),合并Spe=0.87(95%CI=0.77～0.93),Beta=0.33(95%CI=-0.15～0.81),Z=0.135,P=0.179>0.1,Lambda=3.65(95%CI=2.53～4.77),fagan验前概率=58%,+LR=6.7,阳性验后概率=90%,-LR=0.17,阴性验后概率=20%;HR-US诊断不可复性盘前移位(ADDWoR)的合并Sen=0.76(95%CI=0.61～0.86),合并Spe=0.92(95%CI=0.87～0.95),Beta=-0.41(95%CI=-1.17～0.35),Z=-1.05,P=0.294>0.1,Lambda=3.99(95%CI=2.71～5.27),fagan验前概率=38%,+LR=9.8,阳性验后概率=83%,-LR=0.25,阴性验后概率=16%。结论:HR-US诊断ADD具有较高的准确性,对ADDWR的诊断效能高于ADDWoR,适合用于口腔门诊对ADD的快速筛选。

关键词: 超声, 诊断性试验, 颞下颌关节紊乱病, Meta分析, 系统评价

Abstract: PURPOSE: To assess the diagnostic value of high-resolution ultrasonography for detecting anterior disc displacement of temporomandibular joint using HSROC statistical model. METHODS: The relevant trials were searched in the databases of PubMed (1966-2013.9), CNKI(1994-2013.9), CBM(1978-2013.9), Embase(1974-2013.9), VIP(1994-2013.9) database and manual searching was also conducted, two reviewers evaluated the quality of the included trials according to the QUADAS evaluation criterion, the data was extracted and then cross-checked, meta-analysis was conducted by HSROC statistical model, the clinical utility of the results was estimated according to the Fagan’s Nomogram of Bayes'theory. All the included data was analyzed using Stata12.0 software package. RESULTS: Twelve literatures and 1137 subjects were included. The results of HR-US in diagnosis of ADDWR were: the weighted sensitivity and specificity were 0.84 (95%CI=0.76-0.90) and 0.87 (95%CI=0.77-0.93), beta=0.33 (95%CI=0.15-0.81), Z=0.135, P=0.179>0.1, Lambda=3.65 (95%CI=2.53-4.77), fagan pre-test probability =58%, +LR=6.7, positive post-test probability=90%, -LR=0.17, negative post-test probability=20%; The results of HR-US in diagnosis of ADDWoR were: weighted sensitivity and specificity were 0.76 (95%CI=0.61-0.86)and 0.92 (95%CI=0.87-0.95), beta=-0.41 (95%CI=-1.17-0.35), Z=-1.05, P=0.294>0.1, Lambda=3.99 (95%CI=2.71-5.27), fagan pre-test probability =38%,+LR=9.8,positive post-test probability =83%,-LR=0.25, negative post-test probability=16%. CONCLUSIONS: HR-US had good performance in the diagnosis of ADD, it is of superior diagnostic value in detecting ADDWR than ADDWoR, and it can be used as a new clinical diagnosis method for rapid diagnosis of ADD. Supported by Medical Research Projects of Nanjing Military Command, PLA (06MA151, 20080987, Y07010, 11Z007).

Key words: High-resolution ultrasonography, Diagnostic test, Temporomandibular joint disorders, Meta analysis, Systematic review

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