腰椎CT值对骨质疏松症诊断价值的meta分析

doi:10.3969/j.issn.1004-583X.2022.11.002

摘要/Abstract

摘要：

目的应用meta分析对腰椎CT值诊断骨质疏松症进行评价。方法检索包括PubMed、Cochrane Library、Web of Science、中国知网、万方及维普等中外数据库中关于腰椎CT值诊断骨质疏松患者的相关研究并提取基本资料和四格表数据(检索时限从建库至2021年12月),利用诊断试验质量评价工具(QUADAS-2)评价纳入研究的偏倚风险。采用Review Manager 5.4、Meta-Disc 1.4进行meta分析。结果本文总共纳入13篇文献,腰椎CT值诊断骨质疏松症按照椎体不同分为L1、L2、L3、L4、L5和L1-L4椎体平均值6个组,因L5和L1-L4椎体纳入的数据各只有一组,因此未进行效应量合并。L1其汇总敏感度为0.75(95% $C I$ :0.72-0.77),汇总特异度为0.72(95% $C I$ :0.70-0.73),拟合SROC曲线下面积为0.8126。L2汇总敏感度为0.73(95% $C I$ :0.70-0.77),汇总特异度为0.75(95% $C I$ :0.73-0.77),拟合 SROC 曲线下面积为0.8010。L3汇总敏感度为0.78(95% $C I$ :0.75-0.81),汇总特异度为0.72(95% $C I$ :0.70-0.74),拟合SROC曲线下面积为0.7935。L4汇总敏感度为0.76(95% $C I$ :0.73-0.79),汇总特异度为0.73(95% $C I$ :0.70-0.75)。结论腰椎CT值在人群中进行骨质疏松症的筛查方面具有一定意义,而其确诊骨质疏松症的能力不佳, 确诊还需结合其他检查结果综合分析。

关键词: 骨质疏松, CT值, 诊断, meta分析

Abstract: Objective To assess the efficacy of computed tomography (CT) values of lumbar spine in diagnosing osteoporosis (OP) by meta-analysis. Methods PubMed, Cochrane Library, Web of Science, CNKI, Wanfang and VIP Data (from the date of each database established to December, 2021) were searched for the studies regarding diagnostic accuracy of CT values of lumbar spine for OP, and the general information and the fourfold table data were extracted. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was used to evaluate the risk of bias of the included studies. Meta-analysis was performed using Review Manager 5.4 and Meta-Disc 1.4. Results According to the vertebral bodies size, the eligible 13 studies were assigned to 6 groups of L1, L2, L3, L4, L5, and the L1-L4 mean Hounsfield units (HU) values. Since only one set of data was included for L5 and the L1-L4 mean HU values, no effect size combination was performed. The pooled sensitivity, pooled specificity, and areas under curve (AUC) of summary receiver operating characteristic (SROC) for L1 were 0.75 (95% $C I$ : 0.72-0.77), 0.72 (95% $C I$ : 0.70-0.73), and 0.8126 respectively; these values for L2 were 0.73 (95% $C I$ : 0.70-0.77), 0.75 (95% $C I$ : 0.73-0.77), 0.8010, respectively; and these for L3 were 0.78(95% $C I$ : 0.75-0.81), 0.72(95% $C I$ : 0.70-0.74), 0.7935, respectively. The pooled sensitivity and pooled specificity for L4 were 0.76 (95% $C I$ : 0.73-0.79) and 0.73(95% $C I$ : 0.70-0.75), respectively. Conclusion CT value of lumbar spine has certain significance in screening OP in different populations, however, its diagnostic ability is poor, the OP diagnosis should be analyzed comprehensively combined with other inspection results.

Key words: osteoporosis, CT values, diagnosis, meta analysis

中图分类号:

R681

陈洁, 陈树, 尹玉峰, 常新, 武剑. 腰椎CT值对骨质疏松症诊断价值的meta分析[J]. 临床荟萃, 2022, 37(11): 970-976.

Chen Jie, Chen Shu, Yin Yufeng, Chang Xin, Wu Jian. Computed tomography values of lumbar spine in diagnosing osteoporosis: A meta-analysis[J]. Clinical Focus, 2022, 37(11): 970-976.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.11.002

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I11/970

图/表 9

图1 文献筛选流程及结果

表1 纳入文献的一般特征及四格表

研究	国家	CT值诊断阈值(HU)	年龄(岁)	样本量	TP	FP	FN	TN
Pickhardt 2013^[4]	美国	L1=135	59.2±12.5	2 040	348	389	113	1 190
Pickhardt 2013^[4]	美国	L2=155	59.2±12.5	2 048	341	388	130	1 189
Pickhardt 2013^[4]	美国	L3=150	59.2±12.5	2 046	356	437	114	1 139
Pickhardt 2013^[4]	美国	L4=145	59.2±12.5	2 021	354	423	114	1 130
Pickhardt 2013^[4]	美国	L5=150	59.2±12.5	1 943	327	387	119	1 110
Jameshouran 2020^[9]	伊朗	L1=160	48.80±14.11	92	29	8	2	53
黄伟刚2021^[10]	中国	L2=72.25	76.45±10.88	95	28	23	8	36
王志忠2021^[11]	中国	L1=113.5	61.1±12.1	95	23	8	15	49
Chia 2021^[12]	马来西亚	L1=149	≥50	50	20	0	5	25
Li 2018^[13]	中国	L1-L5的平均值=136	67	109	56	13	6	34
Pickhardt 2016^[14]	美国	L1=139	62.0±13.1	157	30	51	3	73
Cansu 2020^[15]	土耳其	L3=122	57.6±14.8	111	14	36	4	61
Lee 2015^[16]	韩国	L1=136.15	73.2±11.5	292	161	36	29	66
Lee 2015^[16]	韩国	L2=101.17	73.2±11.5	292	143	23	47	79
Lee 2015^[16]	韩国	L3=105.49	73.2±11.5	292	158	28	32	74
Lee 2015^[16]	韩国	L4=101.92	73.2±11.5	292	147	29	43	73
Cohen 2021^[17]	中东	L1=121	64±12	246	49	70	17	110
Jain 2020^[18]	美国	L1=135	66.4±9.08	313	24	112	10	167
Alacreu 2017^[19]	欧洲	L1=116	62.4±12.38	320	63	84	43	130
Buckens 2015^[20]	荷兰	L1=99/T12=104	57.9±15.2	302	51	46	31	174

图2 应用QUADAS-2评分对纳入文献进行质量评估的情况

表2 不同腰椎的CT值诊断骨质疏松meta分析结果

测量的椎体	敏感度 (95% $C I$ )	特异度 (95% $C I$ )	PLR (95% $C I$ )	NLR (95% $C I$ )	DOR (95% $C I$ )	SROC曲线下面积(AUC)
L1	0.75(0.72-0.77)	0.72(0.70-0.73)	2.54(2.00-3.23)	0.36(0.27-0.48)	7.87(4.77-12.99)	0.8126
L2	0.73(0.70-0.77)	0.75(0.73-0.77)	2.76(2.17-3.51)	0.35(0.31-0.40)	8.17(6.63-10.08)	0.8010
L3	0.78(0.75-0.81)	0.72(0.70-0.74)	2.68(2.34-3.08)	0.30(0.22-0.39)	8.93(6.48-12.31)	0.7935
L4	0.76(0.73-0.79)	0.73(0.70-0.75)	2.77(2.53-3.04)	0.33(0.29-0.38)	8.34(6.7-10.39)	-

表2 不同腰椎的CT值诊断骨质疏松meta分析结果

测量的椎体	敏感度 (95% $C I$ )	特异度 (95% $C I$ )	PLR (95% $C I$ )	NLR (95% $C I$ )	DOR (95% $C I$ )	SROC曲线下面积(AUC)
L1	0.75(0.72-0.77)	0.72(0.70-0.73)	2.54(2.00-3.23)	0.36(0.27-0.48)	7.87(4.77-12.99)	0.8126
L2	0.73(0.70-0.77)	0.75(0.73-0.77)	2.76(2.17-3.51)	0.35(0.31-0.40)	8.17(6.63-10.08)	0.8010
L3	0.78(0.75-0.81)	0.72(0.70-0.74)	2.68(2.34-3.08)	0.30(0.22-0.39)	8.93(6.48-12.31)	0.7935
L4	0.76(0.73-0.79)	0.73(0.70-0.75)	2.77(2.53-3.04)	0.33(0.29-0.38)	8.34(6.7-10.39)	-

图3 L1的CT值对骨质疏松症DOR的森林图

图4 L1的CT值对骨质疏松症诊断合并敏感度的森林图

图5 L1的CT值对骨质疏松症诊断合并特异度的森林图

图6 L1的CT值诊断骨质疏松症的SROC曲线

表3 L1的CT值诊断骨质疏松的亚组分析结果

年龄	纳入研究数量	灵敏度 (95% $C I$ )	特异度 (95% $C I$ )	PLR (95% $C I$ )	NLR (95% $C I$ )	SROC曲线下面积(AUC)
>60岁	6	0.75(0.71-0.79)	0.62(0.59-0.65)	2.02(1.67-2.44)	0.40(0.27-0.59)	0.7502
≤60岁	3	0.75(0.71-0.78)	0.76(0.74-0.78)	3.48(2.53-4.77)	0.33(0.20-0.53)	0.8701
未知	1	-	-	-	-	-

表3 L1的CT值诊断骨质疏松的亚组分析结果

年龄	纳入研究数量	灵敏度 (95% $C I$ )	特异度 (95% $C I$ )	PLR (95% $C I$ )	NLR (95% $C I$ )	SROC曲线下面积(AUC)
>60岁	6	0.75(0.71-0.79)	0.62(0.59-0.65)	2.02(1.67-2.44)	0.40(0.27-0.59)	0.7502
≤60岁	3	0.75(0.71-0.78)	0.76(0.74-0.78)	3.48(2.53-4.77)	0.33(0.20-0.53)	0.8701
未知	1	-	-	-	-	-

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