对比增强CT与超声造影对胆囊局灶性病变诊断价值比较的Meta分析

Comparison between Values of CECT and CEUS in Diagnosis of Focal Gallbladder Lesions: A Meta-Analysis

目的通过Meta分析评价对比增强CT（CECT）和超声造影（CEUS）对胆囊局灶性病变（FGL）的诊断价值。方法检索Pubmed、EMBASE、OVID、Cochrane Library等国外数据库以及中国期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、万方（Wan Fang）、维普（VIP）等中文数据库,查找所有关于CECT及CEUS诊断FGL的中英文文献,检索时间为建库至2016年8月。采用Stata12.0和Meta-Disc1.4软件进行数据分析。结果共纳入25个研究,包括2469例FGL患者。Meta分析结果显示,CECT诊断FGL的敏感度（Sen）_（合并）=0.91[95%CI（0.87,0.94）],特异度（Spe）_（合并）=0.71[95%CI（0.67,0.75）],阳性似然比（＋LR）_（合并）=4.77[95%CI（2.57,8.84）],阴性似然比（-LR）_（合并）=0.12[95%CI（0.09,0.18）],诊断比值比（DOR）_（合并）=44.89[95%CI（17.17,117.35）];CEUS诊断FGL的Sen_（合并）=0.91[95%CI（0.88,0.94）],Spe_（合并）=0.95[95%CI（0.94,0.96）],＋LR_（合并）=12.44[95%CI（8.49,18.25）],-LR_（合并）=0.10[95%CI（0.07,0.14）],DOR_（合并）=139.52[95%CI（73.13,266.20）]。CECT与CEUS诊断FGL的SROC曲线下面积（AUC）分别为0.9627和0.9687,两者差异无统计学意义（Z=0.5435,P〉0.05）。结论 CECT和CEUS诊断FGL具有相似的诊断效能,两种方法各有优势,均为重要的检查方法。受纳入研究质量和数量限制,上述结论尚需更多高质量研究加以验证。

Objective To review the diagnostic value of contrast-enhanced CT（ CECT） and contrast-enhanced ultrasound（ CEUS） for focal gallbladder lesions. Methods Databases including Pub Med,EMbase,OVID,The Cochrane Library,CNKI,CBM,Wan Fang Data and VIP were searched for diagnostic tests about CECT and CEUS for focal gallbladder lesions from inception to August,2016. The meta-analysis was performed by Stata12.0 and Meta-Disc 1.4 software. Results A total of 25 studies were included,including a total of 2469 patients. The results of the meta-analysis showed that：the pooled Sen,Spe,＋ LR,-LR,and DOR（ combined effect and its 95% CI） in the CECT group were 0.91[95% CI（ 0.87,0.94） ],0.71[95% CI（ 0.67,0.75） ],4.77[95% CI（ 2.57,8.84） ],0.12[95% CI（ 0.09,0.18） ],44.89[95%CI（ 17. 17,117. 35） ] and in the CEUS group were 0.91[95% CI（ 0.88,0.94） ],0.95[95% CI（ 0.94,0.96） ],12.44[95% CI（ 8.49,18.25） ],0.10[95% CI（ 0.07,0.14） ],139. 52[95% CI（ 73. 13,266. 20） ]. There was no significant difference between the CECT group（ 0.9627） and the CECT group（ 0.9687） in the area under the summary receiver operating characteristic（ SROC） curve（ Z = 0.5435,P〈0.05）. Conclusion CECT and CEUS have similar diagnostic efficacy for focal gallbladder lesions. Two methods have their own advantages and both of them can be used as important inspection methods. Due to limited quality and quantity of the included studies,more high quality studies are needed to verify the above conclusion.