经支气管镜冷冻肺活检在间质性肺疾病诊断中的应用价值及安全性的Meta分析

Meta-analysis of the value and safety of transbronchial cryobiopsy in the diagnosis of interstitial lung disease

目的:系统评价经支气管镜冷冻肺活检在间质性肺疾病病理诊断中的应用价值及安全性。方法:通过计算机检索中国知网、万方数据库、维普数据库、the Cochrane Library、PubMed、Embase,搜索建库至2020年2月发表的关于比较冷冻肺活检和钳夹活检的临床研究,根据纳排标准筛选文献,然后对纳入文献进行质量评价和数据提取。使用用RevMan 5.3软件和Stata 15软件进行Meta分析。结果:共纳入8项研究,冷冻肺活检组979例,钳夹活检组963例。Meta分析结果显示:与钳夹活检相比,经冷冻肺活检的标本更大(MD=9.94,95%CI:8.19~11.70,P<0.00001),诊断率更高(RR=1.54,95%CI:1.31~1.82,P<0.00001),出血风险更高(RR=1.52,95%CI:1.35~1.72,P<0.00001),中重度出血风险更高(RR=1.84,95%CI:1.23~2.76,P=0.003),气胸风险更高(RR=1.99,95%CI:1.08~3.65,P=0.03);另外汇总TBCB的诊断率为67%(ES=0.67,95%CI:0.59~0.75),出血发生率为63%(ES=0.63,95%CI:0.43~0.82),中重度出血发生率为13%(ES=0.13,95%CI:0.05~0.24),气胸发生率为6%(ES=0.06,95%CI:0.04~0.08)。结论:在对间质性肺疾病进行病理诊断时,经支气管冷冻肺活检比钳夹活检诊断率高,同时也伴随着更高的出血和气胸风险,但是冷冻肺活检并发症总体可控,是一项相对安全的操作,值得临床推广。

Objective:To systematically evaluate the value and safety of transbronchial cryobiopsy in the pathological diagnosis of interstitial lung disease.Methods:In the computer search and retrieval of CNKI,Wanfang database,viper database,the Cochrane Library,PubMed,Embase,we searched for clinical studies on the comparison of transbronchial cryobiopsy and transbronchial forceps biopsy.The search time was from the establishment of the database to February 2020.Screening literature according to inclusion and exclusion criteria,then the quality evaluation and data extraction of the included literature were carried out,and Meta-analysis was carried out with RevMan 5.3 software and Stata 15 software.Results:A total of 8 studies were included,including 979 cases in the transbronchial cryobiopsy group and 963 cases in the transbronchial forceps biopsy group.Meta-analysis results show that compared with the transbronchial forceps biopsy,specimens undergoing transbronchial cryobiopsy were larger(MD=9.94,95%CI:8.19 to 11.70,P<0.00001),with a higher diagnostic rate(RR=1.54,95%CI:1.31 to 1.82,P<0.00001),a higher risk of bleeding(RR=1.52,95%CI:1.35,1.72,P<0.00001),a higher risk of moderate to severe bleeding(RR=1.84,95%CI:1.23 to 2.76,P=0.003),and a higher risk of pneumothorax(RR=1.99,95%CI:1.08 to 3.65,P=0.03).In addition,the diagnostic rate of TBCB was 67%(ES=0.67,95%CI:0.59 to 0.75),the incidence of bleeding was 63%(ES=0.63,95%CI:0.43 to 0.82),the incidence of moderate to severe bleeding was 13%(ES=0.13,95%CI:0.05 to 0.24),and the incidence of pneumothorax was 6%(ES=0.06,95%CI:0.04,0.08).Conclusion:In the pathological diagnosis of interstitial lung disease,the transbronchial cryobiopsy has a higher diagnostic rate than the transbronchial forceps biopsy,and is also associated with higher risks of bleeding and pneumothorax.However,the complications of the transbronchial cryobiopsy are generally controllable,and therefore,the transbronchial cryobiopsy is a relatively safe operation and worthy of clinical promotion.