吕浩源+王前江+江新

[摘要] 目的 应用Meta分析评价超声检查骶髂关节对强直性脊柱炎的诊断价值，为临床诊断提供依据。 方法 计算机检索PubMed、EMbase、Cochrane Library、中国知网、中国生物医学文献数据库、万方、维普数据库，查找超声检查骶髂关节诊断强直性脊柱炎的诊断性试验，检索时限均为建库至2017年8月1日。由2名研究员按照纳入与排除标准筛选文献、提取数据并采用Revman 5.3工具评价纳入研究的偏倚风险，然后采用Meta-Disc 1.4软件进行Meta分析。 结果 共纳入5篇文献，包括350例受试者。异质性检验结果提示纳入研究之间存在统计学异质性，采用随机效应模型进行Meta分析。Meta分析结果显示：超声检查骶髂关节诊断强直性脊柱炎的敏感度，特异度，阳性似然比，阴性似然比，诊断比值比分别为0.78（95%CI：0.74～0.82）、0.87（95%CI：0.82～0.91）、5.71（95%CI：3.99～8.15）、0.25（95%CI：0.16～0.39）和27.79（95%CI：11.18～69.06）。SROC曲线下面积为0.9298。 结论 超声检查骶髂关节是一种较好的诊断强直性脊柱炎的无创检查方法。受纳入研究数量和质量的限制，上述结论尚需要更多研究予以验证。

[关键词] 超声；强直性脊柱炎；骶髂关节；Meta分析；诊断性试验

[中图分类号] R687.3 [文献标识码] A [文章编号] 1673-7210（2018）01（c）-0064-06

[Abstract] Objetive To evaluate the diagnostic value of sacroiliac joint ultrasound examination in ankylosing spondylitis （AS） and provide evidence for clinical diagnosis. Methods The databases of PubMed， EMbase， Cochrane Library， CNKI， China biology medicine disc， wangfang and VIP were retrieved about ultrasound diagnosis test of ultrasonographic examination for AS in sacroiliac joint. The retrieval time from database built to August 1th， 2017. Two reviewers independently screened and extracted literatures according to inclusion and exclusion criteria. The Revman 5.3 software was applied to assess the risk bias and then Meta-analysis was performed by using Meta-Disc 1.4 software. Results A total of 5 articles involving 350 patients were included. The results of heterogeneity test revealed that there was statistical heterogeneity among the results of the studies， random effects model was adopted for Meta-analysis. The results of Meta-analysis showed that the pooled sensitivity， specificity， positive likelihood ratio， negative likelihood ratio， diagnosis odds ratio for ultrasound checking in sacroiliac joints diagnosis were 0.78 （95%CI： 0.74-0.82）， 0.87 （95%CI：0.82-0.91）， 5.71 （95%CI： 3.99-8.15）， 0.25 （95%CI： 0.16-0.39）， 27.79 （95%CI：11.18-69.06） respectively. The area under the SROC curve was 0.9298. Conclusion Ultrasound in diagnosis of sacroiliac joint in patients with AS is a good non-invasive method as a routine examination. Due to the limited quality and quantity of included samples， the above conclusion is needed to be validated by more high-quality studies.

[Key words] Ultrasound； Ankylosing spondylitis； Sacroiliac joint； Meta-analysis； Diagnostic Test

強直性脊柱炎（ankylosing spondylitis，AS）的早期症状不显著，主要表现为双侧髋部和腰部偶有酸痛，并逐渐自觉扭腰活动不利，有时伴有晨僵，经伸展、旋转后症状减轻，但平日久坐后上述症状又会凸显，多发于20～44岁的青年男性。由于该疾病的病因尚不明确，该疾病目前的治愈成功率仍不理想[1-2]，其治疗的关键点在于早诊断、早治疗。目前早期诊断所运用的影像学方法，一般采用双……