磁共振弹性成像对肝纤维化分级诊断价值研究：Meta分析

发布时间：2018-03-03 04:24

  本文选题：磁共振弹性成像　切入点：肝纤维化　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:采取Meta分析方式,探讨磁共振弹性成像(MRE)对肝纤维化分级诊断优势及临床适用性价值,为临床肝纤维化治疗提供有效依据。材料与方法:1、筛选文献:搜索2017年2月2日前国内、外公开发表的磁共振弹性成像肝纤维化分期中文及英文文献。纳入数据库包括万方数据库(WANFANG DATA),中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普资讯网(VIP)、EMBASE、PUBMED、Cochrane Library、Web of Science,并辅以手工查找相关文献,根据预先纳入及排除标准进行筛选。2、文献质量评价:依据诊断性Meta分析专用文献质量评价工具QUADAS-2(the Quality Assessment for Studies of Diagnostic Accuracy)进行文献质量评价,并进行文献A、B等级分类。3、在纳入文献中提取所需数据,并进行数据处理。(1)提取文献中所需数据,制成表格。(2)对各组数据进行异质性检验,计算I2值判定异质性水平。无明显异质性:I250%,异质性较大:I2≥50%。根据异质性检测结果采用相应模型进行合并统计量。(3)应用stata12.0软件分别对F0 VS F1-F4病例组、F0-F1 VS F2-F4病例组、F0-F2 VS F3-F4病例组、F0-F3 VS F4病例组敏感度(Sensitivity,SEN)、特异度(Specificity,SPE)、阳性似然比(PosititiveLikelihood Ratio,+LR)、阴性似然比(Negative Likelihood Ratio,-LR)、诊断比值比(Diagnostic Odds Ratio,DOR)进行合并及异质性检验,绘制分层综合受试者工作特征曲线(Hierarchical Summary Receiver Operating Characteristic,HROC),并计算曲线下面积(the Area Under the Receiver Operating Characteristic Curve,AUROC),对磁共振弹性成像肝纤维话分级诊断价值进行评估。(4)通过计算本研究中各病例组的验后概率,并假设验前概率为25%、50%、75%,计算验后概率,通过Fagan Plot分析对MRE肝纤维化分级诊断临床适用性进行评估。(5)若纳入文献异质性较大,通过阈值效应及非阈值效应对其异质性来源进行探讨。结果:1、筛选文献:初步检索出1332篇,最后纳入22篇,其中英文21篇,中文1篇。2、文献质量评价:A级文献4篇,B级文献18篇。3、F0 VS F1-F4病例组、F0-F1 VS F2-F4病例组、F0-F2 VS F3-F4病例组、F0-F3 VS F4病例组敏感度、特异度异质性均具有较大异质性。4、(1)采用混合双变量模型进行合并统计量。F0 VS F1-F4病例组:SEN合并、SPE合并、+LR合并、-LR合并、DOR、AUROC值分别为88.8%(85.0-91.7)、95.9%(91.5-98.0)、21.435(10.215-44.979)、0.117(0.086-0.159),183.187(72.533-462.650)、0.96(0.94-0.98)。F0-F1 VS F2-F4病例组:SEN合并、SPE合并、+LR合并、-LR合并、DOR、AUROC分别为93.3%(89.2%-35.9%)、94.1%(90.2%-96.5%)、15.839(9.344-26.848)、0.072(0.044-0.117)、221.224(100.980-484.648)、0.98(0.96-0.99);F0-F2 VS F3-F4病例组:SEN合并、SPE合并、+LR合并、-LR合并、DOR、AUROC分别为92.9%(88.9-95.5)、94.6%(91.2-96.8)、17.348(10.496-28.671)、0.075(0.048-0.119)、230.434(111.482-476.317)、0.98(0.96-0.99)。F0-F3 VS F4病例组:SEN合并、SPE合并、+LR合并、-LR合并、DOR、AUROC分别为97.7%(93.0-99.3)、93.2%(90.3-95.2)、14.337(9.910-20.742)、0.025(0.008-0.075)、580.405(144.871-2325.307)、0.98(0.96-0.99);(2)Fagan分析结果:F0 VS F1-F4病例组:患病率为69.8%,阴性验后概率21%,阳性验后概率98%。假设验验前概率25%、50%、75%时,其阴性验后概率4%、10%、26%,阳性验后概率88%、96%、98%。F0-F1 VS F2-F4病例组:患病率58.5%,阴性验后概率9%,阳性验后概率96%,假设验验前概率25%、50%、75%时,其阴性验后概率2%、7%、18%,阳性验后概率84%、94%、98%。F0-F2 VS F3-F4病例组:患病率41.6%,其阴性验后概率1%,阳性验后概率84%。假设验验前概率25、50%、75%时,其阴性验后概率2%、7%、18%,阳性验后概率85%、95%、98%。F0-F3 VS F4组病例组:患病率26.3%,其阴性验后概率1%,阳性验后概率84%。假设验验前概率25%、50%、75%时,其阴性验后概率1%、2%、7%,阳性验后概率83%、93%、98%。(3)异质性分析结果:本Meta分析异质性主要来源于非阈值效应,不存在阈值效应引起的异质性。结论:磁共振弹性成像(MRE)作为一种新型的、无创的影像检查手段,对肝纤维化各级均具有较高诊断价值,并具有较好的临床适用性,可以为临床精准治疗提供可靠参考。
[Abstract]:Objective: to take Meta analysis of magnetic resonance elastography (MRE) on liver fibrosis diagnostic superiority and clinical applicable value, provide an effective basis for clinical treatment of hepatic fibrosis. Materials and methods: 1. Screening Literature: search domestic before February 2, 2017, magnetic resonance elastography for liver fibrosis staging and published Chinese English included in the literature. The database includes Wanfang database (WANFANG DATA), Chinese biomedical literature database (CBM), China HowNet (CNKI), VIP information network (VIP), EMBASE, PUBMED, Cochrane Library, Web of Science, supplemented by manual search of relevant literature, according to the inclusion and exclusion criteria for screening.2, the quality of literature the evaluation of diagnostic Meta: Based on the analysis of special literature quality assessment tool QUADAS-2 (the Quality Assessment for Studies of Diagnostic Accuracy) for quality evaluation of literature and literature, A, B The classification of.3, in the literature for extracting the required data, and data processing. (1) data, extract the required documents made form. (2) to test for heterogeneity of the statistical data, the calculation of I2 value to determine the heterogeneity level. No significant heterogeneity: I250%, heterogeneity: I2 = 50%. according to the heterogeneity test results using the corresponding model combined with statistics. (3) the application of stata12.0 software F0 VS F1-F4 respectively in the case group, F0-F1 VS F2-F4 F0-F2 VS case group, F3-F4 group, F0-F3 VS F4 group (Sensitivity, SEN) sensitivity, specificity (Specificity, SPE), positive likelihood ratio (PosititiveLikelihood Ratio, +LR), negative likelihood ratio (Negative Likelihood Ratio, -LR), diagnostic odds ratio (Diagnostic Odds Ratio, DOR) were combined and heterogeneity test, drawing layered integrated receiver operating characteristic curve (Hierarchical Summary Receiver Operating Characteris Tic, HROC), and calculate the area under the curve (the Area Under the Receiver Operating Characteristic Curve, AUROC), to evaluate the value of magnetic resonance imaging of liver fibrosis elastic grading diagnosis. (4) the posterior probability was calculated in the study group, and assuming that the prior probability was 25%, 50%, 75% and calculate the posterior probability, through Fagan Plot analysis to evaluate the MRE grading of liver fibrosis diagnosis and clinical applicability. (5) if the literature heterogeneity, the heterogeneity of the sources are discussed through the threshold effect and non effect. Results: 1 screening Literature: preliminary selected 1332 articles, 22 articles were included at last among them, English 21, Chinese 1.2, quality evaluation of literature: a literature 4, B grade 18 references.3, F0 VS F1-F4 F0-F1 VS F2-F4 case group, the case group, F0-F2 VS F3-F4 F0-F3 VS F4 case group, the case group sensitivity, specificity and heterogeneity has great heterogeneity .4, (1) the mixed bivariate model with statistic.F0 VS F1-F4 in the case group: SEN merger, SPE merger, +LR merger, merged with -LR, DOR, AUROC values were 88.8% (85.0-91.7), 95.9% (91.5-98.0), 21.435 (10.215-44.979), 0.117 (0.086-0.159), 183.187 (72.533-462.650), 0.96 (0.94-0.98).F0-F1 VS F2-F4 case group: SEN SPE +LR merger, merger, merger, merged with -LR, DOR, AUROC were 93.3% (89.2%-35.9%), 94.1% (90.2%-96.5%), 15.839 (9.344-26.848), 0.072 (0.044-0.117), 221.224 (100.980-484.648), 0.98 (0.96-0.99); F0-F2 VS F3-F4 case group: SEN merger with SPE, +LR and -LR, with DOR, AUROC, respectively, 92.9% (88.9-95.5), 94.6% (91.2-96.8), 17.348 (10.496-28.671), 0.075 (0.048-0.119), 230.434 (111.482-476.317), 0.98 (0.96-0.99).F0-F3 VS F4 case group: SEN merger, SPE merger, +LR merger, -LR merger, DOR, AUROC were 97.7% (93.0-99.3), 93 .2%(90.3-95.2),14.337(9.910-20.742),0.025(0.008-0.075),580.405(144.871-2325.307),0.98(0.96-0.99);(2)Fagan鍒嗘瀽缁撴灉:F0 VS F1-F4鐥呬緥缁，

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