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青光眼成像装置的诊断准确性:一个meta分析 Diagnostic accuracy of imaging devices in glaucoma: A meta-analysis

Fallon M, Valero O, Pazos M, Antón A

期刊名称:Survey of Ophthalmology

卷期:2017年第62卷第4期

摘要

摘要:像海德堡视网膜断层扫描仪-3HRT3),扫描激光偏振仪(GDx),和光学相干断层成像(OCT)这些成像设备在青光眼诊断中发挥着重要作用。我们开展了一项关于循证数据系统搜索的前瞻性研究,对HRT3GDxOCT的诊断准确性进行了评估。并计算出三者的诊断比值比(DOR)。为了比较各种仪器和参数之间的准确性,我们采用的是meta分析方法来分层总结接收者操作特征模型。并且采用第2版诊断准确性研究的质量评价工具来对偏倚风险进行评估。关于采用这几种仪器进行筛查项目背景下的研究则被用于定性分析。一共有86篇文献被纳入了本项研究的范围。其中OCTDOR值为29.5GDxDOR值为18.6HRTDOR值为13.9。异质性分析结果表明,青光眼的严重程度和患者所属种族对诊断准确性具有统计学意义上的显著影响。用以分析早期青光眼患者的相关研究则表现出较差的诊断结果。患者选择的偏倚风险很大。与meta分析方法中的筛选结果相比,筛选研究表现出较低的青光眼诊断灵敏度,并且特异性相似。综上,GDxHRTOCT的分类能力均较高,并且三者较为接近。但OCT可获得最高的评估DOR。此外,在涵盖预先已确诊为青光眼的受试者群体的研究中,诊断准确性可能被高估。

 

Imaging devices such as the Heidelberg retinal tomograph-3 (HRT3), scanning laser polarimetry (GDx), and optical coherence tomography (OCT) play an important role in glaucoma diagnosis. A systematic search for evidence-based data was performed for prospective studies evaluating the diagnostic accuracy of HRT3, GDx, and OCT. The diagnostic odds ratio (DOR) was calculated. To compare the accuracy among instruments and parameters, a meta-analysis considering the hierarchical summary receiver-operating characteristic model was performed. The risk of bias was assessed using quality assessment of diagnostic accuracy studies, version 2. Studies in the context of screening programs were used for qualitative analysis. Eighty-six articles were included. The DOR values were 29.5 for OCT, 18.6 for GDx, and 13.9 for HRT. The heterogeneity analysis demonstrated statistically a significant influence of degree of damage and ethnicity. Studies analyzing patients with earlier glaucoma showed poorer results. The risk of bias was high for patient selection. Screening studies showed lower sensitivity values and similar specificity values when compared with those included in the meta-analysis. The classification capabilities of GDx, HRT, and OCT were high and similar across the 3 instruments. The highest estimated DOR was obtained with OCT. Diagnostic accuracy could be overestimated in studies including prediagnosed groups of subjects.


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