三种影像学检查评价克罗恩病诊断价值的Meta分析  

Meta-analysis of the diagnostic value of three imaging techniques in Crohn＇s disease

作　　者：王萍[1,2] 吴建新[1] 葛文松[1] 陈颖伟[1] 唐东[1] 范建高[1] 

机构地区：[1]上海交通大学医学院附属新华医院消化科,200092 [2]新华医院崇明分院消化科

出　　处：《中华消化杂志》2013年第5期316-320,共5页Chinese Journal of Digestion

摘　　要：目的采用Meta分析评价CT小肠造影（CTE）、MRI小肠造影（MRE）和超声对CD的诊断价值。方法以节段性肠壁增厚和强化为CD影像学诊断指标，内镜、病理学及随访结果为诊断标准，制定检索式及文献纳入标准，搜索并筛选符合纳入标准的CTE、MRE和超声诊断CD的文献。应用诊断试验研究质量评价（QUADAs）量表进行文献质量评价，并比较CTE、MRE和超声在敏感度、特异度、阳性似然比、阴性似然比、阳性预测值（PPV）、阴性预测值（NPV）等方面的诊断效能。结果检索到的2197篇文献中，符合纳入标准的文献共12篇，其中9篇为盲法研究。按3种不同影像技术分组进行QUADAS量表评分，由于有l篇为CTE与MRE的对比性研究，故CTE组文献计6篇，评分均〉10分，均采用盲法；MRE组计4篇文献，均采用盲法，其中3篇评分〉10分；超声组3篇文献中2篇采用盲法，1篇评价为不清楚，1篇评分〉10分。CTE组敏感度（89％）最高，特异度（90％）低于超声组（95％）。超声组PPV（93％）、NPV（95％）、阳性似然比（15．16）及阴性似然比（0．17）最高，CTE组PPV（91％）、NPV（82％）、阳性似然比（6．25）、阴性似然比（0．15）其次，MRE组敏感度（74％）、特异度（84Voo）、PPV（80％）、NPV（80％）、阳性似然比（4．18）、阴性似然比（O．33）均低于超声组和CTE组。结论CTE在CD诊断的敏感度方面优于MRE和超声，但其他诊断评价指标均比超声差。超声对CD的诊断价值虽高，但仍需更多设计良好的大样本试验进行评估。Objective To evaluate the diagnostic value of computed tomography enteroclysis/ enterography （CTE）, magnetic resorance enteroelysis/enterography （MRE） and ultrasonography （US） in Crohn＇s disease （CD） by Meta-analysis. Methods Segmental intestinal wall thickening and strengthening was taken as image diagnostic indicators in CD. Endoscopic and histopathologic findings and follow-up results were set as diagnostic standard. Retrieve and literature inclusion criteria were developed. The papers of CD diagnosed by CTE, MRE and US which met the criteria were searched and screened. The quality of the papers was evaluated by quality assessment of diagnostic accuracy studies （QUADAS）. The diagnostic efficacy of CTE, MRE and US was compared, which included sensitivity, specificity, positive likelihood ratio and negative likelihood ratio, positive predictive value （PPV） and negative predictive value （NPV）. Results Among the 2197 retrieved literature, a total of 12 papers met the criteria and nine of which were blinded study. The papers were grouped by three different imaging techniques and underwent QUADAS scale scoring. One paper was about CTE and MRE comparative study, so there were six papers in CTE group, the scores of all the six papers were over 10 and all of them were blinded study. There were four papers in MRE group, the scores of three papers were over 10 and all of them were blinded study. There were three papers in US group, the score of one paper was over 10 and two of these three papers were blinded study and one with unclear evaluation. The sensitivity of CTE group was the highest （89%）, while the specificity （90%） was lower than that of US group （95%）. The PPV （93%）, NPV （95%, positive likelihood ratio （15.16） and negative likelihood ratio （0. 17） of US group were the highest, those of CTE were secondary （PPV 91%, NPV 82%, positive likelihood ratio 6. 25 and negative likelihood ratio 0. 15）. The sensitivity （74%）, specificity （84%）, PPV （80%

关 键 词：克罗恩病 体层摄影术 X线计算机 磁共振成像 超声检查 META分析 

分 类 号：R816[医药卫生—放射医学] R57[医药卫生—临床医学] R44