谐波造影增强内镜超声检查对胰腺占位良恶性鉴别的Meta分析

A meta-analysis of contrast-enhanced harmonic endoscopic ultrasonography on differential diagnosisof pancreatic mass

目的评价谐波造影增强内镜超声检查（CEH-EUS）对胰腺肿块良恶性鉴别的价值。方法检索多个中英文数据库收集相关文献，对文献进行筛选和评估，提取相关资料，使用Metadisc 1.4和STATA 14.0软件对提取数据进行Meta分析。结果共纳入16篇文献1 352例患者，计算合并敏感度为93%（95%CI：92%～95%）、特异度为84%（95%CI：80%～87%）、阳性似然比为5.82（95%CI：4.06～8.33）、阴性似然比为0.08（95%CI：0.06～0.10）、诊断比值比为77.33（95%CI：52.37～114.17），总受试者工作特征曲线下面积为0.96（95%CI：0.94～0.97）。亚组分析提示病例数、研究地域、QUADAS评分、病变平均大小、病变类型、超声诊断者经验非异质性产生的原因。剔除偏倚较大的2篇文献后，异质性降至可接受范围，合并敏感度、特异度、阳性似然比、阴性似然比无显著变化，Meta分析结果可靠。 结论CEH-EUS对胰腺占位性病变良恶性判断的准确性高，可作为鉴别胰腺占位性病变良恶性的有效诊断方法。

ObjectiveTo estimate the value of contrast-enhanced harmonic endoscopic ultrasonography （CEH-EUS） on differential diagnosis of pancreatic mass.MethodsMultiple Chinese and English databases were retrieved to selected relevant literature. The quality of literature was assessed, and the data were meta-analyzed using Metadisc 1.4 and STATA 14.0 software.ResultsA total of 16 researches with 1 352 patients were included. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio was 93% （95%CI： 92%-95%）, 84% （95%CI： 80%-87%）, 5.82 （95%CI： 4.06-8.33）, 0.08 （95%CI： 0.06-0.10）, and 77.33 （95%CI： 52.37-114.17）, respectively. The area under the summary receiver operating characteristic curve was 0.96 （95%CI： 0.94-0.97）. The results of subgroup analysis demonstrated that the number of cases, region, QUADAS scores, the diameter and type of mass, and the experience of diagnostician were not the source of heterogeneity. After 2 articles with larger bias were eliminated, the heterogeneity dropped to an acceptable range, and the pooled sensitivity, specificity, positive predictive value and negative predictive value had no significant change. All these suggested that the results of meta-analysis were reliable. Conclusion CEH-EUS has a high accuracy in differential diagnosis of pancreatic mass, and can be used as an effective diagnostic method.