超声造影与增强CT对肾囊性病变诊断价值的Meta分析

发布时间：2018-03-28 10:05

本文选题：肾脏囊性病变　切入点：超声造影　出处：《河北医科大学》2017年硕士论文

【摘要】：目的:采用Meta分析的方法评价超声造影与增强CT鉴别肾脏囊性病变良恶性的诊断价值。方法:制定纳入标准和排除标准,通过计算机检索PubMed、cochrane图书馆、Embase、中国知网、万方数据服务平台等数据库,采用主题词和自由词相结合、手工检索和网络检索相结合的检索方式,且对纳入文献的参考文献均进行二次检索。检索词包括超声造影、增强CT、肾囊性病变等,检索时限均从建库至2016年12月,搜集超声造影与增强CT对肾脏囊性病变的诊断性试验的中英文文献。依据纳入标准和排除标准,由2位评价者独立筛选出符合标准的相关文献、提取资料并用诊断性试验准确性质量评价工具QUADAS评价文献质量,使用Meta-Disc1.4软件,对纳入文献的数据进行异质性检验和阈值效应分析,分别计算出超声造影与增强CT诊断肾脏囊性病变的合并敏感度、特异度、阳性似然比、阴性似然比及诊断比值比,分别绘制两种检查的综合受试者工作特征曲线(SROC),通过二者的曲线下面积评估CEUS与增强CT对肾囊性病变的诊断价值。结果:共纳入8个诊断性试验,包含364个病灶。Meta分析统计结果为,超声造影诊断肾囊性肿瘤的合并敏感度、特异度、阳性似然比、阴性似然比、诊断比值比分别为0.96[95%CI(0.92,0.98)]、0.77[95%CI(0.70,0.83)]、3.69[95%CI(2.87,4.76)]、0.07[95%CI(0.04,0.14)]和54.88[95%CI(25.48,118.24)]。而增强CT依次为0.84[95%CI(0.78,0.89)]、0.81[95%CI(0.75,0.87)]、4.12[95%CI(3.06,5.55)]、0.22[95%CI(0.10,0.45)]和20.74[95%CI(11.44,35.24)]。两者SROC曲线下面积分别为0.9173和0.8634。结论:超声造影较增强CT对肾囊性肿瘤具有较好的诊断价值。并且CEUS对囊性肾癌的检出具有更高的灵敏度,不易遗漏恶性病变。
[Abstract]:Objective: to evaluate the diagnostic value of contrast-enhanced CT and contrast-enhanced CT in the diagnosis of benign and malignant renal cystic lesions by Meta analysis. The database, such as Wanfang data service platform, adopts the combination of subject words and free words, the combination of manual retrieval and network retrieval, and the second retrieval of the references that are included in the literature. The key words include contrast-enhanced ultrasound, The search time of enhanced CT, renal cystic lesions, etc., from the establishment of the library to December 2016, collected the Chinese and English literature on the diagnostic test of renal cystic lesions by contrast-enhanced CT and contrast-enhanced CT, according to the inclusive criteria and exclusion criteria, Two evaluators independently sifted out relevant documents that met the criteria, extracted the data and evaluated the literature quality with diagnostic test accuracy evaluation tool QUADAS, and used Meta-Disc1.4 software to evaluate the literature quality. The combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic ratio ratio of contrast-enhanced CT and contrast-enhanced CT in the diagnosis of renal cystic lesions were calculated by heterogeneity test and threshold effect analysis. The operating characteristic curves of two kinds of integrated subjects were drawn, and the diagnostic value of CEUS and enhanced CT in renal cysts was evaluated by the area under the curves. Results: eight diagnostic tests were included. The combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio of contrast-enhanced ultrasonography in the diagnosis of renal cystic tumors were analyzed. The diagnostic ratios were 0.96 [95CI0.92 0.98)] 0.77 [95CI0.700.83)] 3.69 [95CI2.874.76)] 0.07 [95CII 0.040.14)] and 54.88 [95CI25.48118.24]. The area under the curve of enhanced CT was 0.84 [95CI0.780.89)] 0.81 [95CI0.750.870.87] 4.12 [95CI3.060.55)] 0.22 [95CI11.44.4545] and 20.74 [11.4442435.The area under the curve was 0.9173 and 860.344.Conclusion: enhanced CT is better than enhanced CT in the diagnosis of renal cell carcinoma and CEUS. Has higher sensitivity, It is not easy to omit malignant lesions.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692;R445.1;R816.7

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