摘要
目的系统评价简易精神状态检查量表(MMSE)诊断卒中后认知障碍(PSCI)的诊断准确性以及该量表不同截断值的诊断价值,为MMSE量表最佳阈值的选择提供参考依据。方法计算机检索PubMed、EMbase、Cochrane Library、Web of Science、CINAHL、CBM、VIP、CNKI和WanFang Data数据库,搜集与研究目的相关的诊断性试验,检索时限均为建库至2022年11月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,使用Stata 16.0软件进行Meta分析。结果共纳入23个诊断性试验,包括1525例患者。Meta分析结果显示:双变量混合效应模型:MMSE量表诊断PSCI的最佳截断值为23/24[Sen合并=0.75,95%CI(0.52,0.89);Spe合并=0.90,95%CI(0.81,0.95);DOR=28,95%CI(12,65);AUC=0.92,95%CI(0.89,0.94)];层次综合受试者工作特征(HSROC)曲线模型:Sen合并=0.77,95%CI(0.70,0.83);Spe合并=0.76,95%CI(0.69,0.83),Beta=0.1,95%CI(−0.13,0.33),Z=0.82,P=0.41,Lambda=2.38,95%CI(2.12,2.64),HSROC曲线下面积为0.84。Fagan验前概率为38%,+LR=3.3,阳性验后概率为67%,−LR=0.3,阴性验后概率为16%。结论当前证据表明,MMSE作为PSCI的诊断工具有一定的诊断价值,总体诊断效能中等,且截断值取23/24时诊断效能可能最高。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。
Objective To systematically review the accuracy of the mini-mental state examination scale(MMSE)in the screening of poststroke cognitive impairment(PSCI),and the diagnostic value of different cut-off values of the scale,so as to provide references for the selection of the threshold of the MMSE scale.Methods Databases including PubMed,EMbase,Cochrane Library,Web of Science,CINAHL,CBM,VIP,CNKI,and WanFang data were searched for diagnostic tests about MMSE for PSCI from inception to November 2022.Two researchers independently screened the literatures,extracted data and assessed the risk of bias of the included studies.Then,meta-analysis was performed by Stata 16.0 software.Results A total of 23 studies involving 1525 patients were included.The results of meta-analysis showed that after the analysis of bivariate mixed effect model,the optimal cutoff value of MMSE scale was 23/24(the pooled sensitivity=0.75,95%CI 0.52 to 0.89;the pooled Specificity=0.90,95%CI 0.81 to 0.95;DOR=28,95%CI 12 to 65;AUC=0.92,95%CI 0.89 to 0.94).The results of hierarchical summary receiver-operating characteristic(HSROC)curve model showed that the pooled sensitivity=0.77,95%CI 0.70 to 0.83;the pooled specificity=0.76,95%CI 0.69 to 0.83,Beta=0.1,95%CI−0.13 to 0.33,Z=0.82,P=0.41,Lambda=2.38,95%CI 2.12 to 2.64,and the area under the SROC curve was 0.84.Fagan pre-test probability was 38%,positive likelihood ratio was 3.3,positive post-test probability was 67%,negative likelihood ratio was 0.3,negative post-test probability was 16%.Conclusion The current evidence shows that MMSE has a certain diagnostic value as a screening tool for PSCI,the overall diagnostic efficacy is moderate,and the diagnostic value is highest when the cut-off value is 23/24.Due to the limited quality and quantity of the included studies,more high quality studies are required to verify the above conclusion.
作者
吴婷婷
陈孝利
魏晓琴
钱晓玲
张梓尧
韩琳
马玉霞
WU Tingting;CHEN Xiaoli;WEI Xiaoqin;QIAN Xiaoling;ZHANG Ziyao;HAN Lin;MA Yuxia(Evidence-Based Nursing Center,School of Nursing,Lanzhou University the First School of Clinical Medicine,Lanzhou 730000,P.R.China;Ward IV,Department of Neurology,Second Hospital of Lanzhou University,Lanzhou 730000,P.R.China;Lanzhou University of Arts and Science,Lanzhou 730000,P.R.China;Nursing Department,Gansu Provincial People’s Hospital,Lanzhou 730000,P.R.China)
出处
《中国循证医学杂志》
CSCD
北大核心
2023年第8期923-929,共7页
Chinese Journal of Evidence-based Medicine
基金
甘肃省自然科学基金项目(编号:22JR5RA218)
兰州大学医学教育创新发展项目(编号:lzuyxcx-2022-221)
中华医学会医学教育分会和中国高等教育学会医学教育专业委员会2020年医学教育研究课题(编号:20B1374)
甘肃省卫生健康行业科研计划项目(编号:GSWSHL2021-016)
兰州大学第二医院萃英科技创新临床护理研究项目(编号:CY2021-HL-05)。
作者简介
共同第一作者:吴婷婷;共同第一作者:陈孝利;通信作者:韩琳,Email:hanlin@lzu.edu.cn;通信作者:马玉霞,Email:yuxiama@lzu.edu.cn。
