快速现场评估联合超声支气管镜下穿刺诊断肺/纵隔病变的系统评价与Meta分析  

Rapid on-site evaluation combined with endobronchial ultrasound for the diagnosis of pulmonary/mediastinal lesions:A systematic review and meta-analysis

作　　者：唐正能 葛杰 龚丽明[1] 王东坤 邱浩 TANG Zhengneng;GE Jie;GONG Liming;WANG Dongkun;QIU Hao(Department of Thoracic and Cardiovascular Surgery,The First People’s Hospital of Kunming City,Kunming,650034,P.R.China;The First Affiliated Hospital of Kunming Medical University,Kunming,650532,P.R.China)

机构地区：[1]昆明市第一人民医院胸心外科,昆明650034 [2]昆明医科大学第一附属医院,昆明650532

出　　处：《中国胸心血管外科临床杂志》2024年第7期1043-1049,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：昆明市卫生健康委员会卫生科研课题项目(2020-04-02-111)。

摘　　要：目的 系统评价快速现场评估(rapid on-site evaluation,ROSE)在超声支气管镜(endobronchial ultrasound,EBUS)下肺及纵隔病变穿刺活检中的诊断价值。方法 计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、中国知网、万方和维普数据库,搜集EBUS联合ROSE穿刺诊断肺/纵隔病变的研究,检索时限均从建库至2022年8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,采用RevMan 5.4和Stata 12.0软件进行Meta分析。结果 共纳入15篇文献,包括9篇回顾性研究和6篇前瞻性研究,共计3 577例患者。对主要结局指标的Meta分析结果显示:ROSE联合EBUS组的样本充分性[RD=0.10,95%CI(0.05,0.15),P<0.000 1]、总体诊断率[RD=0.07,95%CI(0.04,0.10),P<0.000 1]、恶性病变诊断率[RD=0.06,95%CI(0.02,0.09),P=0.004]显著高于EBUS组。对肺部病变和纵隔病变诊断率进行亚组分析,结果显示ROSE联合EBUS组对肺部病变[RD=0.12,95%CI(0.08,0.17),P<0.000 01]及纵隔病变[RD=0.06,95%CI(0.01,0.12),P=0.02]的诊断率高于EBUS组,差异均有统计学意义。ROSE联合EBUS的总体诊断率、恶性诊断率分别为90%、92%。对次要结局指标的Meta分析结果显示:ROSE联合EBUS组较EBUS组穿刺次数[MD=-1.16,95%CI(-1.89,-0.43),P=0.002]显著减少,两组手术操作时间[MD=0.09,95%CI(-5.22,5.39),P=0.97]及并发症发生率[RD=-0.06,95%CI(-0.13,0.01),P=0.1]差异无统计学意义。结论 ROSE可以提高EBUS在肺/纵隔病变中的诊断效能,有临床运用价值。Objective To systematically review the value of rapid on-site evaluation(ROSE) for diagnosing pulmonary and mediastinal lesions with endobronchial ultrasound(EBUS).Methods PubMed,EMbase,The Cochrane Library,Web of Science,CNKI,Wanfang,and VIP databases were searched by computer to collect the studies of ROSE and EBUS in the diagnosis of pulmonary and mediastinal lesions from inception to August 2022.Two researchers independently screened the literature,extracted the data,and evaluated the risk of bias in the included studies.Metaanalysis was implemented by RevMan 5.4 and Stata 12.0 software.Results A total of 15 studies(9 retrospective studies and 6 prospective studies) with 3 577 patients were included.The meta-analysis results of main outcomes showed that the adequacy of the sample(RD=0.10,95%CI 0.05 to 0.15,P<0.000 1),overall diagnosis rate(RD=0.07,95%CI 0.04 to 0.10,P<0.000 1) and the diagnosis rate of the malignant lesion(RD=0.06,95%CI 0.02 to 0.09,P=0.004) of the ROSE combined with EBUS group were significantly higher than those of the EBUS group.Subgroup analysis showed that the diagnosis rates of pulmonary lesions(RD=0.12,95%CI 0.08 to 0.17,P<0.000 01) and mediastinal lesions(RD=0.06,95%CI 0.01 to 0.12,P=0.02) in the ROSE group was significantly higher than those in the EBUS group.The overall diagnosis rate and malignant diagnosis rate of ROSE combined with EBUS were 90% and 92%.The meta-analysis results of secondary outcomes showed that the number of lesions punctures(MD=-1.16,95%CI -1.89 to -0.43,P=0.002) in the ROSE combined with EBUS group were significantly less than that in the EBUS group;there was no statistical difference in operation time(MD=0.09,95%CI -5.22 to 5.39,P=0.97) or incidence of complications(RD=-0.06,95%CI -0.13 to 0.01,P=0.1) between the two groups.Conclusion ROSE can improve the diagnostic efficiency of EBUS in pulmonary and mediastinal lesions,and has the value of the clinical application.

关 键 词：快速现场评估 超声支气管镜 穿刺活检 肺部病变 纵隔病变 系统评价/META分析 

分 类 号：R563[医药卫生—呼吸系统] R564[医药卫生—内科学]