超声及MRI诊断妊娠期阑尾炎:Meta分析

Ultrasound and MRI in diagnosis of appendicitis in pregnancy:Meta-analysis

目的采用Meta分析方法评价超声、MRI对妊娠期阑尾炎的诊断效能。方法检索Cochrane Library、Pubmed、Embase、中国知网、万方医学网和维普数据库中关于超声和/或MRI诊断妊娠期阑尾炎的文献,检索时间从建库至2019年9月。依据纳入及排除标准筛选文献,并进行质量评价。采用Stata15.0、Meta-Disc1.4软件进行统计分析。结果最终纳入19篇文献(2379例疑诊妊娠期阑尾炎患者),仅超声诊断妊娠期阑尾炎文献4篇,仅MRI诊断11篇,同时采用超声及MRI诊断4篇。超声对妊娠期阑尾炎的诊断敏感度和特异度分别为0.68[95%CI(0.60,0.75)]和0.98[95%CI(0.95,0.99)],诊断比值比及受试者工作特征(ROC)曲线下面积(AUC)分别为12.53[95%CI(5.78,27.19)]和0.86。MRI对妊娠期阑尾炎的诊断敏感度和特异度分别为0.95[95%CI(0.91,0.98)]和0.98[95%CI(0.97,0.98)],诊断比值比及AUC分别为331.84[95%CI(161.42,682.16)]和0.99,其AUC明显高于超声(Z=7.41,P<0.001)。结论MRI对妊娠期阑尾炎的诊断效能明显高于超声。

Objective To observe the diagnostic value of ultrasound and MRI for appendicitis of pregnancy by meta-analysis.Methods Cochrane Library,PubMed,Embase,CNKI,Wanfang Med Online and VIP databases were searched for studies using ultrasound and/or MRI in diagnosis of appendicitis of pregnancy from published up to September 2019.Stata15.0 and Meta-Disc1.4 software were used for statistical analysis.Results Nineteen articles(2379 patients with suspected appendicitis of pregnancy)were enrolled,including 4 articles using only ultrasound,11 articles using only MRI and 4 articles using both ultrasound and MRI at the same time.In diagnosis of appendicitis of pregnancy,the sensitivity of ultrasound was 0.68(95%CI[0.60,0.75])and specificity was 0.98(95%CI[0.95,0.99]),the diagnostic odds ratio was 12.53(95%CI[5.78,27.19])and area under the receiver operating characteristic(ROC)curve(AUC)was 0.86;while the sensitivity of MRI was 0.95(95%CI[0.91,0.98])and specificity was 0.98(95%CI[0.97,0.98]),the diagnostic odds ratio was 331.84[95%CI(161.42,682.16)]and AUC was 0.99,significantly higher than AUC of ultrasound(Z=7.41,P<0.001).Conclusion The diagnostic efficacy of MRI for appendicitis in pregnancy was significantly higher than that of ultrasound.