MRCP在活体肝移植术前供者胆管解剖结构评估中应用价值的荟萃分析

Magnetic resonance cholangiopancreatography classification of the bile duct anatomy of liver transplantation living donor： a meta-analysis

目的评价磁共振胰胆管成像（MRCP）在评估活体肝移植术前供者胆管解剖结构中的应用价值。方法检索Cochrane图书馆、MEDLINE、EMBASE、中国生物医学文献数据库等文摘数据库收录的中英文文献摘要，辅以Springer、OVID、Sciencedirect等全文数据库，按照Cochrane协作网推荐的诊断试验纳入标准筛选文献，采用循证医学软件包检验纳入文献的异质性，并选择相应的效应量合并模型，对纳入的研究进行加权合并，计算敏感性、特异性、阳性预测值、阴性预测值、诊断比值比，绘制汇总受试者工作特征曲线（SROC），计算曲线下面积，最后进行敏感性分析。结果符合纳入标准的文献有17篇，共有34项研究，异质性检验发现各研究间存在异质性，进行荟萃回归分析发现异质性来源为MRCP成像方法，按照不同的MRCP成像方法进行亚组分析，各亚组内异质性检验未发现异质性。按照固定效应模型获得厚层MRCP、三维MRCP、厚层MRCP与三维MRCP结合、增强MRCP等亚组的汇总敏感性分别为0．89、0．92、0．95和1．00，特异性分别为0．78、0．80、0．82和0．76，阳性预测值分别为4．1、4．5、5．2和4．1，阴性预测值分别为0．14、0．10、0．06和0，诊断比值比分别为29、45、85和1228，SROC曲线下面积分别为0．83、0．92、0．96和0．99。结论厚层MRCP和三维MRCP相结合在评估活体肝移植供者术前胆管解剖结构中具有很高的敏感性和特异性，完全可以满足术前对胆管结构评估的要求。

Objective To systematically evaluate the diagnostic value of magnetic resonance cholangiopancreatography （MRCP） in the investigation of bile duct anatomy of liver transplantation living donors. Methods A search in Cochrane library, MEDLINE, EMBASE, CBMdisc （China Biology Medicine disc） was performed to identify relevant English and Chinese^language abstracts, supplemented by Springer, OVID, Sciencedirect full text database, etc. Criteria for inclusion were based on validity criteria for diagnostic research published by the Cochrane collaboration. With Meta analysis package for Statal0. 1, heterogeneity of the included articles was tested, which was used to select proper effect model to calculate pooled weighted sensitivity and specificity, positive likelihood ratio, negative likelihood ratio. Summary receiver operating characteristic （SROC） curve was performed and the area under the curve （AUC） was calculated. Finally, sensitivity analysis was performed. Results Seventeen articles with 34 studies were included. Heterogeneity analysis revealed heterogeneity between studies and the source was MRCP imaging methods spotted by meta-regression analysis. Subgroup analysis according to MRCP imaging methods showed homogeneity within subgroups. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odd ratio of breath-holding thick slice MRCP, 3D MRCP, the combination of the prior two methods, contrast enhance MRCP were 0.89, 0.78, 4. 1, 0. 14, 29% 0.92, 0.80, 4.5, 0. 10, 45% 0.95, 0.82, 5.2, 0.06, 85% and 1.00, 0. 76, 4. 1, 0, 1228, respectively with fixed effect model analysis. The area under the SROC curve was 0. 83, 0. 92, 0. 96 and 0. 99 respectively. Conclusion The combination of thick slice and 3D MRCP is a practical and effective method with good sensitivity and specificity to investigate bile duct anatomy of living liver transplantation donors, which fully meets the requirements of the preoperative assessment of bile duct structure.