Detrano R, Janosi A, Lyons K P, Marcondes G, Abbassi N, Froelicher V F
Veterans Administration Medical Center, Long Beach, California 90822.
Am J Med. 1988 Apr;84(4):699-710. doi: 10.1016/0002-9343(88)90107-6.
Technical and methodological factors might affect the reported accuracies of diagnostic tests. To assess their influence on the accuracy of exercise thallium scintigraphy, the medical literature (1977 to 1986) was non-selectively searched and meta-analysis was applied to the 56 publications thus retrieved. These were analyzed for year of publication, sex and mean age of patients, percentage of patients with angina pectoris, percentage of patients with prior myocardial infarction, percentage of patients taking beta-blocking medications, and for angiographic referral (workup) bias, blinding of tests, and technical factors. The percentage of patients with myocardial infarction had the highest correlation with sensitivity (0.45, p = 0.0007). Only the inclusion of subjects with prior infarction and the percentage of men in the study group were independently and significantly (p less than 0.05) related to test sensitivity. Both the presence of workup bias and publication year adversely affected specificity (p less than 0.05). Of these two factors, publication year had the strongest association by stepwise linear regression. This analysis suggests that the reported sensitivity of thallium scintigraphy is higher and the specificity lower than that expected in clinical practice because of the presence of workup bias and the inappropriate inclusion of post-infarct patients.
技术和方法学因素可能会影响所报道的诊断试验准确性。为评估其对运动铊闪烁扫描术准确性的影响，我们对医学文献（1977年至1986年）进行了非选择性检索，并对由此检索到的56篇出版物进行了荟萃分析。分析内容包括出版年份、患者的性别和平均年龄、心绞痛患者的百分比、既往心肌梗死患者的百分比、服用β受体阻滞剂药物患者的百分比，以及血管造影转诊（检查）偏倚、试验设盲和技术因素。心肌梗死患者的百分比与敏感性的相关性最高（0.45，p = 0.0007）。只有纳入既往有梗死的受试者以及研究组中男性的百分比与试验敏感性独立且显著相关（p < 0.05）。检查偏倚的存在和出版年份均对特异性有不利影响（p < 0.05）。在这两个因素中，出版年份通过逐步线性回归显示出最强的关联。该分析表明，由于存在检查偏倚以及不恰当地纳入梗死后期患者，所报道的铊闪烁扫描术的敏感性高于临床实践中的预期，而特异性则低于预期。
