共聚焦内镜诊断胃肠上皮化生及胃癌的Meta分析  

Role of confocal microscopic endoscopy in the diagnosis of gastrointestinal epithelia metaplasia and gastric cancer:a Meta-analysis

作　　者：张记霞 杜飞燕 王子卓 刘家龙 赵秋[1] 刘静[1] ZHANG Jixia;DU Feiyan;WANG Zizhuo;LIU Jialong;ZHAO Qiu;LIU Jing(Department of Gastroenterology,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院消化内科,湖北武汉430071

出　　处：《胃肠病学和肝病学杂志》2024年第10期1313-1322,共10页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的运用Meta分析方法探究共聚焦显微内镜(confocal lasser endomicroscopy,CLE)对胃肠上皮化生(gastrointestinal epithelial metaplasia,GIM)及胃癌的诊断价值。方法系统检索PubMed、Cochrane Library、Web of Science、CNKI、万方、Sinomed数据库,搜集CLE诊断GIM及胃癌的相关文献,搜索时间为建库至2022年10月,根据评价诊断性试验质量表(QUADAS-2)对纳入文献行质量评价;采用Review Manager 5.4和Stata 15.0软件行Meta分析,采用随机效应模型计算合并敏感度、特异度、阳性似然比(positive likelihood ratio,PLR)、阴性似然比(negative likelihood ratio,NLR)、诊断比值比(diagnostic ratio,DOR)及95%CI,进行SROC拟合分析,通过I 2评价由非阈值效应所致的异质性,若存在明显异质性,进一步进行回归分析判断产生异质性来源;采用Deek’s漏斗图和Fagan图,评估发表偏倚及验前、验后概率。结果最终GIM组中纳入7篇文献,胃癌组中纳入6篇文献,发现CLE诊断GIM及胃癌的合并敏感度分别为0.88和0.96,合并特异度分别为0.93和0.94,PLR分别是12.43和17.34,NLR分别是0.13和0.04,DOR分别为98.96和416.87,SROC下面积分别为0.92和0.98。Fagan图显示CLE诊断胃肠上皮化生时,明确患有该病变的概率为93%,排除GIM时,明确患有该病变的概率为11%,诊断胃癌时,明确患有该病变的概率为95%,排除胃癌时,明确患有该病变的概率为4%。纳入研究间存在较高异质性,经计算各研究间不存在阈值效应及发表偏倚,进一步行回归分析发现GIM组异质性来源于其他非变量因素,胃癌组异质性较大的原因来源于CLE诊断状态。结论基于本Meta分析结果发现,CLE对GIM及胃癌具有较好的诊断价值,可作为临床诊断辅助工具。Objective To study the diagnostic value of confocal lasser endomicroscopy(CLE)in gastrointestinal epithelial metaplasia(GIM)and gastric cancer by Meta-analysis.Methods The databases of PubMed,Cochrane Library,Web of Science,CNKI,Wanfang Data and Sinomed were searched for related studies published up to Oct.2022,and the quality of the included literatures was evaluated according to QUADAS.The random effect model was used to calculate the combined sensitivity,specificity,positive likelihood ratio(PLR),negative likelihood ratio(NLR),diagnostic ratio(DOR)and 95%CI,and the pooled receiver operating characteristic curve(SROC)fitting analysis was performed to calculate the area under the curve.Evaluating heterogeneity caused by non-threshold effect by I 2,and if there was obvious heterogeneity,further judging the source of heterogeneity by regression score;Deek′s funnel diagram and Fagan diagram were used to evaluate the publication bias and the probability before and after the test.Results In the end,7 articles were included in the GIM group and 6 articles were included in the gastric cancer group.There was high heterogeneity among the included articles,and there was no threshold effect and publication bias.It was found that the summarized sensitivity of GIM and gastric cancer for CLE diagnosis were 0.88 and 0.96,the summarized specificity was 0.93 and 0.94,the PLR was 12.43 and 17.34,the NLR was 0.13 and 0.04,the DOR was 98.96 and 416.87,and the area under SROC was 0.92 and 0.98,respectively.Fagan diagram showed that the probability of GIM was 93%when CLE diagnosed GIM,11%when GIM was excluded,95%when gastric cancer was diagnosed,and 4%when gastric cancer was excluded.Meta-regression analysis found that the heterogeneity of GIM group came from other non-variable factors,and the reason for the large heterogeneity of gastric cancer group came from CLE diagnosis state.Conclusion Based on the results of this Meta-analysis,CLE has good diagnostic value for GIM and gastric cancer,and can be used as an auxiliary tool for c

关 键 词：胃癌 胃肠上皮化生 共聚焦内镜 诊断价值 META分析 

分 类 号：R735.2[医药卫生—肿瘤]