Locker T, Goodacre S, Sampson F, Webster A, Sutton A J
School of Health and Related Research, University of Sheffield, Sheffield, UK.
Emerg Med J. 2006 Aug;23(8):630-5. doi: 10.1136/emj.2005.033381.
Plethysmography and rheography techniques have been widely studied as diagnostic tests for deep vein thrombosis (DVT). This study aimed to systematically review the accuracy of these tests for diagnosing clinically suspected DVT.
The following databases were searched: Medline, EMBASE, CINAHL, Web of Science, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, Database of Reviews of Effectiveness, the ACP Journal Club (1966 to 2004), and citation lists of retrieved articles. Studies that compared plethysmography or rheography to a reference standard of ultrasound or contrast venography were selected. Standardised data were extracted and study quality determined against validated criteria. Data were analysed by random effects meta-analysis and meta-regression.
The meta-analysis included 78 studies, reporting 82 patient cohorts. Sensitivity and specificity (95% CI) were: 75% (73% to 77%) and 90% (89% to 91%) for impedance plethysmography, 83% (81% to 85%) and 81% (79% to 82%) for strain-gauge plethysmography, 85% (79% to 90%) and 91% (81% to 95%) for air plethysmography, 91% (87% to 94%) and 71% (66% to 75%) for light-reflex rheography, and 86% (83% to 89%) and 93% (91% to 95%) for phleborheography. Meta-regression was limited by poor reporting of studies. There was some evidence that diagnostic performance depended on the proportion of males in the cohort and reporting of study setting.
Although plethysmography and rheography techniques add diagnostic value, they have inadequate diagnostic performance to act as a stand-alone test in DVT diagnosis. Evaluation of their role in combination with other tests, or standardised clinical assessment, is required.
作为诊断深静脉血栓形成（DVT）的检测方法，体积描记法和血流描记法已得到广泛研究。本研究旨在系统评价这些检测方法诊断临床疑似DVT的准确性。
检索了以下数据库：医学索引数据库（Medline）、荷兰医学文摘数据库（EMBASE）、护理学与健康领域数据库（CINAHL）、科学引文索引数据库（Web of Science）、Cochrane系统评价数据库、Cochrane对照试验注册库、有效性评价数据库、美国医师协会杂志俱乐部（1966年至2004年）以及检索到文章的参考文献列表。选择将体积描记法或血流描记法与超声或静脉造影参考标准进行比较的研究。提取标准化数据，并根据经过验证的标准确定研究质量。通过随机效应荟萃分析和荟萃回归对数据进行分析。
荟萃分析纳入了78项研究，报告了82个患者队列。电阻抗体积描记法的敏感性和特异性（95%可信区间）分别为：75%（73%至77%）和90%（89%至91%）；应变片体积描记法为83%（81%至85%）和81%（79%至82%）；空气体积描记法为85%（79%至90%）和91%（81%至95%）；光反射血流描记法为91%（87%至94%）和71%（66%至75%）；静脉血流描记法为86%（83%至89%）和93%（91%至95%）。荟萃回归因研究报告不佳而受到限制。有证据表明诊断性能取决于队列中男性的比例以及研究背景的报告情况。
尽管体积描记法和血流描记法技术具有诊断价值，但它们的诊断性能不足以在DVT诊断中作为独立检测方法。需要评估它们与其他检测方法联合使用或标准化临床评估中的作用。
