内镜窄带成像技术对比常规白光内镜对结直肠腺瘤及息肉检出的Meta分析

发布时间：2018-03-03 23:35

本文选题：内镜窄带成像技术　切入点：结直肠肿瘤　出处：《重庆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景:在常规的白光内镜(white light colonoscopy,WLC)检查中,腺瘤的漏诊率高达22%,寻找一种新的、能够提高腺瘤检出率(adenoma detection rate,ADR)的内镜技术显得非常重要。目前已有多个随机对照研究(randomized controlled trials,RCT)比较了内镜下窄带成像技术(narrow band imaging,NBI)与WLC对结肠息肉与腺瘤的诊断价值,但结论并不一致,因此我们有必要进行Meta分析。目的:明确NBI是否能够提高结直肠ADR。方法:在MEDLINE、Embase、Pub Med、Cochrane、中国知网、维普网、万方数据知识服务平台等数据库中使用“colorectal neoplasm”、“colonoscop*or endoscop*”、“NBI”and“electronic chromo endoscopy”、“结直肠肿瘤”、“结肠镜”、“内镜窄带成像技术”、“电子染色内镜”词条组合进行检索,检索时间从建库至2016年12月。结果:最终纳入了16项比较NBI和WLC腺瘤或者息肉检出效率的RCT进行Meta分析。与WLC相比,NBI在总的ADR及息肉检出率(polyp detection rate,PDR)方面没有统计学差异(NBI vs.WLC,ADR:38.3%vs.36.6%,P=0.08,RR 1.06;95%CI 0.99-1.12,I~2=5%;PDR:43.6%vs.41.3%,P=0.14,RR 1.07;95%CI 0.98-1.18,I~2=59%)。根据结肠镜分辨率的差异进行亚组分析后发现,高分辨率窄带成像技术(high definition narrow band imaging,HD-NBI)的PDR高于WLC(68.8%vs.60.4%,P=0.008,RR 1.14;95%CI 1.03-1.25,I~2=8%)。并且,在扁平状腺瘤的检出率方面,NBI优于WLC且具有统计学差异(23.4%vs.15.8%,P=0.03,RR 1.53;95%CI 1.03-2.27,I~2=56%)。分析病灶检出平均数(所有检出病灶数/所有参与者人数),NBI与WLC相比,腺瘤检出平均数(the mean adenoma per patient,APP)和息肉检出平均数(the mean polyp per patient,PPP)均没有统计学差异(NBI vs.WLC APP:1.183 vs.1.098,P=0.47,MD 0.03;95%CI-0.05 to 0.12,I~2=0%;PPP:1.152 vs.1.043,P=0.41,MD 0.14;95%CI-0.19 to 0.47,I~2=96%);但是对于扁平状腺瘤的APP,NBI明显优于WLC,且具有统计学差异(0.668 vs.0.588,P=0.03,MD 0.12;95%CI 0.01-0.24,I~2=0%)。就腺瘤及息肉的漏诊率而言,NBI与WLC没有统计学差异(22.7%vs.20.7%,P=0.17,RR 1.12;95%CI 0.96-1.30,I~2=38%;22.2%vs.26.0%,P=0.23,RR 0.85;95%CI 0.66-1.10,I~2=63%)。结论:总体而言,NBI并不能提高结直肠ADR及PDR、降低漏诊率,但是HD-NBI可以提高PDR;NBI有助于提高结直肠扁平状腺瘤的检出。
[Abstract]:Background: in the routine white light colonoscopy WLC examination, the missed diagnosis rate of adenoma is as high as 22%, looking for a new type of adenoma. Endoscopic technique which can improve the detection rate of adenoma detection is very important. At present, random controlled trialsrCTs have been used to compare narrow band imaging with WLC in the diagnosis of colonic polyps and adenomas. But the conclusions are not consistent, so we need to do Meta analysis. Objective: to determine whether NBI can improve colorectal ADR.Methods: in MEDLINE Embase Pub Medtrode Cochrane, China knowledge Network, Weip Web, "colorectal neoplasm", "colonoscop*or endoscopes *", "NBI" and "electronic chromo endoscopy", "Colorectal neoplasms", "colonoscopy", "Endoscopic narrowband imaging", "Electronic staining endoscopy" are used in the database. The retrieval time ranged from the construction of the database to December 2016. Results: 16 RCT items comparing the detection efficiency of NBI and WLC adenoma or polyp were analyzed by Meta. Compared with WLC, there was no statistical analysis on total ADR and polyp detection polyp detection rate. NBI vs.WLCV ADR: 38.3vs.36.6U P0.08R1.0695 CI 0.99-1.12I2N 2Q + 5: PDR43.6vs.41.30.14RR 1.0795RR 1.08-1.18IK 259B. according to the difference in colonoscopy resolution, a subgroup analysis was carried out. High resolution narrow-band imaging technique with high definition narrow band imagingHD-NBI has a higher PDR than WLC68.8vs.60.4 P0. 008RR 1.1495. In the detection rate of flat adenoma, NBI is superior to WLC and has statistical difference (23.4vs.15.8R 1.5395CI 1.03-2.27 CI 1.03-2.27). The average number of lesions detected (the number of lesions detected / the number of all participants) was compared with that of WLC. There was no statistical difference between the average of the mean adenoma per per APP and the average of polyp detection the mean polyp per spp.) there was no statistical difference between the mean vs.WLC APP:1.183 vs.1.098 P0. 487MD 0.03 95CI-0. 05 to 0. 12 per P0. 05. PPP: 1. 152 vs.1.043 P0. 41MD 0.14CI-0.19 to 0. 47 I296A; but for flat adenoma, APPNBI was significantly superior to WLCMD, and the difference was 0. 668 vs.0. 588m P0.03D. There was no statistical difference between NBI-0.1295 CI 0.01-0.24 CI and WLC in terms of the rate of missed diagnosis of adenoma and polyp. There was no statistical difference between NBI and WLC. P0.17RR 0.96-1.129595 CI 0.96-1.30 I = 22.2vs.26.0P0.2395CI 0.8595CI 0.66-1.10 I263630.Conclusion: overall, NBIs can not improve ADR and PDRs, and decrease the rate of missed diagnosis. However, HD-NBI can improve the detection of colorectal flat adenoma.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R574.6;R735.34

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