颈动脉内膜切除术中心体感诱发电位和经颅多普勒超声对脑缺血检测的比较分析：网状Meta分析和临床数据的见解
Comparative Analysis of Somatosensory-Evoked Potentials and Transcranial Doppler Ultrasound for Cerebral Ischemia Detection in Carotid Endarterectomy: Insights from Network Meta-Analysis and Clinical Data.
作者信息
Cheng Dejing, Yang Siyuan, Ji Chengyuan
机构信息
The Forth Affiliated Hospital of Soochow University, Su Zhou, China.
The First Affiliated Hospital of Soochow University, Su Zhou, China.
出版信息
World Neurosurg. 2024 Nov;191:e674-e689. doi: 10.1016/j.wneu.2024.09.023. Epub 2024 Sep 10.
OBJECTIVE
This study aims to compare the diagnostic efficacy of somatosensory-evoked potentials (SEPs) and transcranial Doppler sonography (TCD) for monitoring cerebral tissue ischemia during carotid endarterectomy (CEA) using network meta-analysis and retrospective analysis of clinical data.
METHODS
For the meta-analysis, we conducted a comprehensive search of 4 electronic databases (PubMed, EMBASE, Cochrane, and Web of Science) from inception to September 2023, resulting in the inclusion of 52 relevant articles. Additionally, a retrospective study was conducted at our hospital, involving patients who underwent CEA surgery from July 2019 to July 2021.
RESULTS
The network meta-analysis incorporated 52 articles, with ranking results indicating that SEP demonstrated superior performance in specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy with surface under the cumulative ranking curve values of 99.9%, 93.8%, 96.6%, and 99.9%, respectively. Furthermore, TCD exhibited the highest sensitivity with a surface under the cumulative ranking value of 92.0%. A total of 190 patients meeting inclusion criteria were included in the retrospective study. The area under the curve for SEP's receiver operating characteristic curve was 0.787, compared to TCD's area under the curve of 0.606. SEP demonstrated a sensitivity of 66.67%, with a specificity of 90.76%, PPV of 19.05%, NPV of 98.82%, and accuracy of 90%. For TCD, the diagnostic performance measures included a sensitivity of 50.00%, specificity of 71.19%, PPV of 5.35%, NPV of 97.76%, and accuracy of 70.53%. The Fisher's exact test for sensitivity yielded a result of P = 1.000. The χˆ2 test for specificity resulted in χˆ2 = 22.863, with P < 0.001. Continuous correction χˆ2 tests for PPV and NPV showed χˆ2 = 2.005 (P = 0.157) and χˆ2 = 0.069 (P = 0.793), respectively. Additionally, the χˆ2 test for accuracy showed χˆ2 = 22.742, with P < 0.001.
CONCLUSIONS
During CEA, SEP appears to provide a slightly more reliable indication of the ischemic condition in cerebral tissues compared to TCD.
目的
本研究旨在通过网络荟萃分析和临床数据回顾性分析，比较体感诱发电位（SEP）和经颅多普勒超声（TCD）在颈动脉内膜切除术（CEA）期间监测脑组织缺血的诊断效能。
方法
对于荟萃分析，我们对4个电子数据库（PubMed、EMBASE、Cochrane和Web of Science）从创建到2023年9月进行了全面检索，纳入了52篇相关文章。此外，在我院进行了一项回顾性研究，纳入了2019年7月至2021年7月接受CEA手术的患者。
结果
网络荟萃分析纳入52篇文章，排名结果表明SEP在特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性方面表现更优，累积排序曲线下面积值分别为99.9%、93.8%、96.6%和99.9%。此外，TCD的敏感性最高，累积排序值下面积为92.0%。回顾性研究共纳入190例符合纳入标准的患者。SEP的受试者操作特征曲线下面积为0.787，而TCD的曲线下面积为0.606。SEP的敏感性为66.67%，特异性为90.76%，PPV为19.05%，NPV为98.82%，准确性为90%。对于TCD，诊断性能指标包括敏感性50.00%，特异性71.19%，PPV为5.35%，NPV为97.76%，准确性为70.53%。敏感性的Fisher精确检验结果为P = 1.000。特异性的χ²检验结果为χ² = 22.863，P < 0.001。PPV和NPV的连续校正χ²检验分别显示χ² = 2.005（P = 0.157）和χ² = 0.069（P = 0.793）。此外，准确性的χ²检验结果为χ² = 22.742，P < 0.001。
结论
在CEA期间，与TCD相比，SEP似乎能更可靠地提示脑组织的缺血状况。
Zotero 插件