本文選題：腎臟囊性病變　切入點(diǎn)：超聲造影　出處：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:采用Meta分析的方法評(píng)價(jià)超聲造影與增強(qiáng)CT鑒別腎臟囊性病變良惡性的診斷價(jià)值。方法:制定納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn),通過(guò)計(jì)算機(jī)檢索PubMed、cochrane圖書館、Embase、中國(guó)知網(wǎng)、萬(wàn)方數(shù)據(jù)服務(wù)平臺(tái)等數(shù)據(jù)庫(kù),采用主題詞和自由詞相結(jié)合、手工檢索和網(wǎng)絡(luò)檢索相結(jié)合的檢索方式,且對(duì)納入文獻(xiàn)的參考文獻(xiàn)均進(jìn)行二次檢索。檢索詞包括超聲造影、增強(qiáng)CT、腎囊性病變等,檢索時(shí)限均從建庫(kù)至2016年12月,搜集超聲造影與增強(qiáng)CT對(duì)腎臟囊性病變的診斷性試驗(yàn)的中英文文獻(xiàn)。依據(jù)納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn),由2位評(píng)價(jià)者獨(dú)立篩選出符合標(biāo)準(zhǔn)的相關(guān)文獻(xiàn)、提取資料并用診斷性試驗(yàn)準(zhǔn)確性質(zhì)量評(píng)價(jià)工具QUADAS評(píng)價(jià)文獻(xiàn)質(zhì)量,使用Meta-Disc1.4軟件,對(duì)納入文獻(xiàn)的數(shù)據(jù)進(jìn)行異質(zhì)性檢驗(yàn)和閾值效應(yīng)分析,分別計(jì)算出超聲造影與增強(qiáng)CT診斷腎臟囊性病變的合并敏感度、特異度、陽(yáng)性似然比、陰性似然比及診斷比值比,分別繪制兩種檢查的綜合受試者工作特征曲線(SROC),通過(guò)二者的曲線下面積評(píng)估CEUS與增強(qiáng)CT對(duì)腎囊性病變的診斷價(jià)值。結(jié)果:共納入8個(gè)診斷性試驗(yàn),包含364個(gè)病灶。Meta分析統(tǒng)計(jì)結(jié)果為,超聲造影診斷腎囊性腫瘤的合并敏感度、特異度、陽(yáng)性似然比、陰性似然比、診斷比值比分別為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)]。而增強(qiáng)CT依次為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)]。兩者SROC曲線下面積分別為0.9173和0.8634。結(jié)論:超聲造影較增強(qiáng)CT對(duì)腎囊性腫瘤具有較好的診斷價(jià)值。并且CEUS對(duì)囊性腎癌的檢出具有更高的靈敏度,不易遺漏惡性病變。
[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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R692;R445.1;R816.7

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