透视引导下经皮经肝胆管内钳夹活检对胆管狭窄鉴别诊断价值的荟萃分析

Differential diagnostic value of fluoroscopy-guided percutaneous transhepatic forceps biopsy for biliary strictures:a meta-analysis

目的探讨透视引导下经皮经肝胆管钳夹活检(PTFB)对胆管狭窄的诊断价值。方法通过检索PubMed、Embase、Web of Science、Cochrane图书馆、中国知网、万方、维普和中国生物医学文献数据库,获取2001年1月至2022年8月发表的有关PTFB诊断胆管狭窄的文献。制定文献纳入、排除标准并对检索文献进行筛选。采用诊断性研究质量评价量表(QUADAS-2)对纳入文献进行质量评价。使用Meta-disc软件和Stata软件行数据分析。结果最终纳入18篇文献,样本量共1 935例。异质性检验提示无阈值效应,但灵敏度和阴性似然比存在其他原因导致的非阈值性异质性,因此采用随机效应模型进行荟萃分析,其余结局指标异质性较低,采用固定效应模型进行合并。结果显示,透视引导下PTFB对胆管狭窄诊断的灵敏度合并值为0.796(95%CI:0.776~0.814),特异度合并值为1.000(95%CI:0.985~1.000),阳性似然比合并值为21.532(95%CI:11.281~41.098),阴性似然比合并值为0.234(95%CI:0.169~0.323),诊断比值比合并值为94.321(95%CI:46.744~190.320),综合受试者工作特征曲线下面积为0.929。并发症发生率合并值为9.2%(95%CI:6.4%~12.0%)。结论透视引导下PTFB对诊断胆管狭窄具有较高的灵敏度和特异度。

Objective To evaluate the fluoroscopy-guided percutaneous transhepatic forceps biopsy(PTFB)in the diagnosis of biliary strictures.Methods Literatures on diagnosis of biliary strictures by PTFB published from January 2001 to August 2022 were obtained by searching the databases of PubMed,Embase,Web of Science,the Cochrane Library,China National Knowledge Infrastructure(CKNI),Wanfang,VIP,and China Biology Medicine disc(CBM).Literature inclusion and exclusion criteria were established and the retrieved literature was screened.The quality of the included literature was evaluated using the quality assessment of diagnostic accuracy studies(QUADAS-2).Statistical analysis was performed by using Meta-disc software and Stata software.Results Eighteen articles involving 1935 patients were finally included.The heterogeneity test suggested no threshold effect,but there was non-threshold heterogeneity in sensitivity and negative likelihood ratio due to other reasons,so a random-effects model was used,and a fixed-effects model were used for the remaining outcome indexes used due to low heterogeneity.The results showed that the pooled sensitivity of fluoroscopy-guided PTFB for the diagnosis of biliary strictures was 0.796(95%CI:0.776-0.814),the pooled specificity was 1.000(95%CI:0.985-1.000),the pooled positive likelihood ratio was 21.532(95%CI:11.281-41.098),the pooled negative likelihood ratio was 0.234(95%CI:0.169-0.323),the pooled diagnostic odds ratio was 94.321(95%CI:46.744-190.320),and the area under the summary receiver operating characteristic curve was 0.929.The pooled complication rate was 9.2%(95%CI:6.4%-12.0%).Conclusion Fluoroscopy-guided PTFB may be a superior diagnostic tool for biliary strictures.