超声造影在肝硬化背景下对小肝癌诊断价值的Meta分析

Diagnostic value of contrast-enhanced ultrasound for small hepatocellular carcinoma in cirrhotic pallents： a meta-analysis

目的评价超声造影在肝硬化背景下对小肝癌的诊断价值。方法计算机检索1995至2012年4月Medline、PubMed、FMJS、中国知网、维普数据、万方数据及中国生物医学文献数据库，收集有关超声造影在肝硬化背景下诊断小肝癌的文献。由两位研究者根据纳入与排除标准独立筛选文献、提取资料，采用诊断精确性研究的质量鉴定法进行质量评价以及Meta-Disc1．4软件进行Meta分析。对数据进行Spearman相关分析、x2检验、Cochranp检验。结果共纳入符合标准的6篇文献（380个病灶），根据研究中造影剂不同分为Levovist组和Sonovue组分别进行Meta分析。Sonovue组和Levovist组在肝硬化背景下对小肝癌的诊断，其合并灵敏度、特异度、阳性似然比、阴性似然比、诊断比值比分别为0．73[95％可信区间（CI）为0．67～0．79]和0．76（95％CI为0．60～0．89）、0．89（95％ CI 为0．81～0．94）和0．79（95％CI为0．61～0．91）、6．53（95％CI为2．74～15．52）和3．60（95％CI为1．89～6．85）、0．26（95％CI为0．13～0．54）和0．21（95％CI为0．02～2．63）、27．50（95％CI为7．99～94．72）和25．74（95％CI为5．30～125．04）。Sonovue组综合受试者工作特征曲线下面积=0．9252（Q=0．8595）。结论超声造影对肝硬化背景下的小肝癌有较高的诊断价值。

Objective To perform a meta-analysis of contrast-enhanced ultrasound （CEUS） as a diagnostic tool for small hepatocellular carcinoma （HCC） in patients with cirrhosis. Methods A computerbased retrieval system was first used to identify reports on the diagnostic efficacy of CELTS for small HCC in patients with cirrhosis that were published between 1995 and April 2012 in the following literature databases： Medline, PubMed, Foreign Medical Journal Service （FMJS）I China National Knowledge Infrastructure （CNKI）, VIP Journal Integration Platform （VJIP）, Wanfang Chinese Periodical Database, and Chinese Biomedicine Database （CBM）. Two investigators, working independently, then selected cases from the relevant based upon specific inclusion and exclusion criteria. The extracted data was subjected to quality assessment of diagnostic accuracy studies （QUADAS）. The MetaDisc version 1.4 software was used to conduct meta-analyses. Results Six studies, involving 380 lesions detected by various contrast mediums, were selected for analysis. Diagnosis of small HCC in patients with cirrhosis by CEUS based on Sonovue and Levovist had pooled sensitivities of 0.73 （95% confidence interval （C/）： 0.67-0.79） and 0.76 （95% CI： 0.60-0.89）, pooled specificities of 0.89 （95% C1： 0.81-0.94） and 0.79 （95% C[： 0.61-0.91）, pooled positive likelihood ratios of 6.53 （95% CI： 2.74-15.52） and 3.60 （95% CI： 1.89-6.85）, pooled negative likelihood ratios of 0.26 （95% CI： 0.13-0.54） and 0.21 （95% CI： 0.02-2.63）, and pooled diagnostic odds ratios of 27.50 （95% C1： 7.99-94.72） and 25.74 （95% CI： 5.30-125.04）, respectively. The area under the curve of the summary receiving operating characteristic （SROC） of CEUS based on Sonovue was 0.9252 and the Q＊ index was 0.8595. Condusion CEUS is a valuable diagnostic tool for small HCC in cirrhotic patients.