超声支气管镜引导经支气管针吸活检在胸内淋巴结核诊断中的准确性和安全性分析  

Diagnostic efficacy and safety of endobronchial ultrasound-guided transbronchial needle aspiration in intrathoracic tuberculosis:a meta analysis

作　　者：张梦 陈慧冬[1] 詹枝华[1] Zhang Meng;Chen Huidong;Zhan Zhihua(Department of Respiratory Disease Intervention,Wuhan Jinyintan Hospital,Wuhan Medical Treatment Center,Wuhan 430023,China)

机构地区：[1]武汉市金银潭医院武汉市医疗救治中心呼吸病介入诊疗科,湖北武汉430023

出　　处：《临床荟萃》2018年第12期1071-1076,共6页Clinical Focus

基　　金：武汉市卫生计生委科研计划资助项目(WX18Q38)

摘　　要：目的旨在评价超声支气管镜引导经支气管针吸活检(EBUS-TBNA)在胸内淋巴结核诊断中的准确性和安全性。方法在Pubmed、Cochrane library外文数据库检索相关临床研究,采用Meta-disc软件进行meta分析,计算其敏感度、特异度、似然比、ROC曲线下面积和Q*,meta回归探讨异质性来源。结果最终19篇文献包含1 784例患者纳入研究,EBUS-TBNA在诊断纵隔淋巴结核总的敏感度为0.78(95%CI=0.74～0.81);特异度为1.00(95%CI=0.99～1.00);阳性似然比为54.61(95%CI=30.57～97.57);阴性似然比为0.24(95%CI=0.19～0.31);ROC曲线下面积为0.943,Q*=0.881,meta回归示研究地区和类型不同与研究结果的异质性有关,欧洲地区研究敏感度较亚洲高0.17(95%CI=0.03～0.83,P=0.03),前瞻性研究较回顾性研究高0.20(95%CI=0.04～0.95,P=0.04),差异有统计学意义。仅1例患者发生脓毒血症的严重并发症。结论 EBUS-TBNA对于胸内淋巴结核诊断敏感度高、安全性好,特别是对痰菌阴性而高度怀疑结核分枝杆菌(mycobacterium tuberculosis,MTB)感染的胸内淋巴结肿大的患者具有重要临床应用价值。Objective To evaluate the efficacy and safety of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration(EBUS-TBNA)in Intrathoracic Tuberculosis(TB).Methods Qualified studies were retrieved from PubMed and the Cochrane Library.Meta-disc sofeware was applied to date analysis.The pooled sensitivity,specificity,likelihood ratios,the area under the summary receiver operating characteristic(ROC)and Q point(Q*)were calculated.And Meta-regression was used to analyze the heterogeneity.Results Ultimately 19 studies with 1784 patients were included.The pooled sensitivity and specificity of EBUS-TBNA for diagnosis of intrathoracic TB were0.78(95%confidence interval[CI ],0.74-0.81)and 1.00(95%CI =0.99-1.00),respectively.The positive LR was54.61(95%CI =30.57-97.57);and the negative LR was 0.24(95%CI =0.19-0.31).The area under the summary ROC curve was 0.943,and the Q* was 0.881.Meta-regression showed that region difference and research type were associated with heterogeneity,the sensitibity of EBUS-TBNA for diagnosis of intrathoracic TB in European was 0.17(95%CI =0.03-0.83,P =0.03)higher than in Asian,prospective study with high sensitibility of 0.20(95%CI =0.04-0.95,P =0.04)compared with the retrospective.The difference was statistically significant.Only 1 serious complication of septicopymia occurred.Conclusion EBUS-TBNA is an effective and safe diagnostic tool for intrathoracic TB,especially in patients with negetive sputum of mycobacterium tuberculosis and intrathoracic lymphadenopathy.

关 键 词：超声支气管镜 针吸活检 胸内淋巴结结核 荟萃分析 

分 类 号：R[医药卫生]