超声造影诊断肝包虫病的系统评价和meta分析  

Systematic review and meta-analysis of contrast-enhanced ultrasound in diagnosing hepatic echinococcosis

作　　者：蒲武涛 肖宜欣 妥丽 凯丽比努尔·马木提 范雪婷 崇乐 Pu Wutao;Xiao Yixin;Tuo Li;Kailibinuer·Muti;Fan Xueting;Chong Le(The Third Clinical Medical College of Xinjiang Medical University,Urumqi 830011,China;Department of Ultrasound,Affiliated Tumor Hospital Of Xinjiang Medical University,Urumqi 830011,China)

机构地区：[1]新疆医科大学第三临床医学院,新疆乌鲁木齐830011 [2]新疆医科大学附属肿瘤医院超声科,新疆乌鲁木齐830011

出　　处：《临床荟萃》2025年第3期197-204,共8页Clinical Focus

基　　金：新疆医科大学大学生创新创业训练计划项目超声造影联合PD-1/PD-L1诊断肝包虫病的循证研究(X202320760101);新疆维吾尔自治区自然科学基金新型聚合物复合包膜的纳米超声造影剂的稳定性机制研究(2023D01C134);国家自然科学基金超声激活微泡靶向CD44联合单细胞测序及空间转录组技术探索PD-1抑制剂调控三阴性乳腺癌免疫异质性的研究(82360362)。

摘　　要：目的系统评价超声造影(contrast-enhanced ultrasound,CEUS)诊断肝包虫病的诊断准确性。方法采用主题词与自由词相结合方法制定检索策略,检索PubMed、Embase、Cochrane Library、CBM、CNKI、万方及维普数据库,检索时间从数据库建库到2023年6月。根据纳入与排除标准对检索到的文献进行筛选,纳入符合标准的研究。对纳入研究一般资料及真阳性、假阳性、假阴性及真阴性进行提取,采用QUADAS-2工具对纳入研究进行偏倚风险评估,采用meta-disc1.4和RevMan5.4软件进行meta分析。计算合并敏感度及合并特异度,合并阳性似然比及合并阴性似然比,Meta分析诊断比值比及SROC曲线下面积(AUC),采用Stata14.0软件绘制加尔布雷斯图对数据进行异质性分析。结果根据纳入排除标准共纳入7篇研究,包含348例患者。超声造影诊断肝包虫病的合并敏感度为0.96(95%CI 0.92~0.98),合并特异度为0.88(95%CI 0.79~0.93),合并阳性似然比为5.73(95%CI 1.24~26.58),合并阴性似然比为0.07(95%CI 0.03~0.18),合并诊断OR值为95.32(95%CI 22.02~412.60),AUC为0.9767。根据合并敏感度、合并特异度及SROC曲线的AUC提示CEUS诊断肝包虫病具有较高的诊断效能。绘制加尔布雷斯图,显示所有的研究均处于红色实线效应线两侧,且均在绿色置信区间范围内,提示本研究总体不存在异质性。结论CEUS对于肝包虫的诊断具有较高的效能,可以作为临床诊断肝包虫的一种新方法。Objective To systematically evaluate the diagnostic accuracy of contrast-enhanced ultrasound(CEUS)in diagnosing hepatic echinococcosis.Methods By searching keywords combined with free words,articles reporting CEUS in diagnosing hepatic echinococcosis published before June 2023 were searched in the databases,including Pubmed,EMBASE,Cochrane Library,CBM,CNKI,Wanfang and CQVIP.According to the inclusion and exclusion criteria,eligible articles were screened.Data of general information,true positive,false positive,false negative,and true negative were extracted from the included articles.Using the QUADAS-2 tools to assess the included studies.Meta-disc1.4 and RevMan5.4 software were used for meta-analysis.The pooled sensitivity,specificity,positive likelihood ratio,and negative likelihood ratio were calculated.The diagnostic odds ratio(OR)and area under the SROC curve(AUC)were calculated.Stata14.0 software was used to draw the Galbraith plot to perform heterogeneity analysis on the research data.Results According the inclusion and exclusion criteria,7 articles were included with 348 patients.The pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic OR and AUC of CEUS in diagnosing hepatic echinococcosis was 0.96(95%CI 0.92-0.98),0.88(95%CI 0.79-0.93),5.73(95%CI 1.24-26.58),0.07(95%CI 0.03-0.18),95.32(95%CI 22.02-412.60),and 0.9767,respectively.According to the pooled sensitivity,specificity and AUC,CEUS had a high diagnostic efficacy in diagnosing hepatic echinococcosis.The Galbraith plot showed that all articles were distributed on both sides of the solid red effect line and within the green confidence interval range,indicating no overall heterogeneity in this study.Conclusion CEUS has a high efficacy in the diagnosis of hepatic echinococcosis and can serve as a new method for clinical diagnosis of hepatic echinococcosis.

关 键 词：棘球蚴病 肝 超声造影 敏感性 诊断准确性 

分 类 号：R532.32[医药卫生—内科学]