摘要
目的评估造影增强超声内镜鉴别胰腺肿块良恶性的诊断价值。方法在Medline、PubMed、WebofScience、Embase、Cochrane Central Trials databases、CNKI及维普数据库收集相关文献，由两名评价员独立进行文献选择、质量评估及资料提取。首先使用MetaDiSc1．4软件分析异质性，接着采用随机效应模型（有异质性）或固定效应模型（无异质性）计算合并敏感度、特异度、阳性似然比、阴性似然比等指标，同时绘制汇总受试者工作特征曲线（SROC曲线），然后根据研究对象的特点进行Meta回归分析来寻找潜在引起异质性的因素，同时按Deville介绍的方法筛选并剔除异质性明显的研究进行亚组分析，最后使用Stata10．0软件计算Begg—Mazumdar和Harbord-Egger指数来判断发表偏移并绘制漏斗图。结果纳入文献12篇涉及研究对象共1139例。Meta分析结果提示造影增强超声内镜对胰腺肿块良恶性鉴别的合并敏感度和特异度分别为94％（95％CI：91％～95％）和89％（95％CI：85％～92％），合并阳性似然比为8．09（95％CI：4．47～14．64），合并阴性似然比为0．08（95％CI：0．06～0．10），SROC曲线下面积为0．9732，SE=0．02。剔除2篇引起异质性的研究后亚组分析结果显示，敏感度和特异度分别是93％（95％CI：91％～95％）和93％（95％CI：89％～95％），且敏感度、特异度、阳性似然比和阴性似然比之间不存在异质性，SROC曲线下面积为0．9745，阳=0．02。Begg．Mazumdar法（P=0．244）和Harbord．Egger法（P=0．442）检验发表偏倚结果提示纳入Meta分析的文献结果之间无发表偏倚。结论Meta分析的结果提示造影增强超声内镜对胰腺肿块良恶性鉴别有较高的诊断价值。
Objective To assess the accuracy of contrast-enhanced EUS in differential diagnosis of benign and malignant pancreatic masses. Methods We systematically searched the Medline, PubMed, Web of Science, Embase, Cochrane Central Trials, CNKI and VIP databases for relevant studies published. Study selection, quality assessment and data extraction were performed by two reviewers independently. Meta-Disc （version 1.4） software was used to perform this meta-analysis for sensitivity, specificity, positive likelihood ratio （LR）, and negative LR. Pooling results were derived by using the fixed-effect model when significant heterogeneity was not present. The random-effect model was applied otherwise. A summary receiver-operating characteristic （SROC） curve was constructed. Furthermore, to explore the potential sources of heterogeneity, we used meta-regression to estimate the effect of the following characteristics of the studies on the diagnostic accuracy of contrast-enhanced EUS. In addition, the outliers were identified with the method described by Deville and a subgroup analysis was performed by excluding the outliers. We used Stata statistical software （version 10. 0） to assess the publication bias with the Begg-Mazumdar indictor and HarbordEgger indictor. Results Twelve studies involving 1139 patients were included. The pooled sensitivity ofcontrast-enhanced EUS for the differential diagnosis of pancreatic masses was 94% （95% CI, O. 91 ～0. 95）, the specificity was 89% （95% CI, O. 85 ～0. 92）, the positive LR was 8.09 （95% CI, 4. 47 ～ 14. 64）, and the negative LR was 0, 08 （95% CI, O. 06 ～ 0. 10）. The area under the curve （AUC） under SROC was 0. 9732 （ SE = 0.02）. The subgroup analysis by excluding two outliers provided a sensitivity of 93 % （95% C1, O. 91～0. 95） and a specificity of 93% （95% C1, O. 89～0. 95）. Additionally, the subgroup analysis showed that the heterogeneities were eliminated in pooled estimates when the outliers were excluded and the AUC under SROC was 0. 9745 （SE = 0. 02）. Moreover, no significant publication bias was found with the Begg-Mazumdar indictor （ P = 0.244） or the Harbord-Egger indictor （ P = 0.442 ）. Conclusion Contrastenhanced EUS is a valuable method in the differential diagnosis of pancreatic masses.
出处
《中华消化内镜杂志》
2012年第7期374-379,共6页
Chinese Journal of Digestive Endoscopy
关键词
内窥镜超声检查
图像增强
胰腺肿瘤
META分析
Endoscopic ultrasonography
Image enhancement
Pancreatic neoplasms
Meta-analysis
作者简介
通信作者：诸琦，Email：zhuqi@medmail．com．cn
