磁共振胆胰管成像对肝移植术后胆管狭窄诊断价值的Meta分析

Diagnostic Value of Magnetic Resonance Cholangiopancreatography for Biliary Strictures Post-Orthotopic Liver Transplantation:A Meta-Analysis

目的应用Meta分析探讨磁共振胆胰管成像（MRCP）对于原位肝移植（0LT）术后胆管狭窄的诊断价值。方法系统性地检索近20年来Cochrane图书馆、美国生物医学数据库（Medline）、荷兰医学文摘（Embase）、中国知网（cNKI）检索平台以及万方数据库中MRCP对OLT术后胆管狭窄的诊断价值的研究文献。研究者对文献质量进行严格评价和资料提取，提取符合质量标准的文献中的诊断数据。用Metadisc1．40软件进行Meta分析，合并MRCP诊断OLT术后胆管狭窄的灵敏度、特异度、阴性似然比和阳性似然比，采用拟合受试者工作特征曲线（sROc）进行分析，并计算曲线下面积（AUC）。结果共纳入6个研究，共计261例怀疑胆管狭窄的患者。Meta分析结果显示：MRCP诊断OLT术后胆管狭窄的汇总敏感度和特异度及其各自的95％可信区间（95％cD分别为89％（95％CI：0．83～0．94）和94％（95％CI：0．88～0．98）；汇总阳性似然比及阴性似然比分别为8．04（95％CI：2．83～22．85）及0．11（95％CI：0．04～0．37），AUC为0．961。结论MRCP对于OLT术后胆管狭窄具有较高的诊断价值，应作为OLT术后胆道并发症的常规随访及筛查手段。

Objective To evaluate the diagnostic value of magnetic resonance cholangiopancreatography （MRCP） for biliary strictures post-orthotopic liver transplantation （OLT）. Methods A systematic review was performed by searching electronic bibliographic databases, including the Cochrane Library, Medline, EMbase, CNKI, and WanFang from 1994 to 2014. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were used to describe the diagnostic value. Summary receiver operating characteristic （SROC） curve with area under the SROC curve （AUC） were used to summarize overall diagnostic performance. Results Six studies involving 261 subjects were eligible for the analysis. The summary estimates of pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and AUC of MRCP for the diagnosis of biliary strictures after OLT were 89% （95% CI： 0. 83-0. 94）, 94% （95% CI： 0. 88-0. 98）, 8.04 （95% CI： 2.83-22.85）, 0. 11 （95% C1： 0. 04-0. 37）, and 0. 961, respectively. Conclusion MRCP is a sensitive and specific technique to diagnose biliary strictures after OLT