本文選題：甲狀腺結(jié)節(jié) + 超聲��； 參考：《廣西醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的：通過(guò)對(duì)超聲、針吸細(xì)胞學(xué)、放射性核素掃描對(duì)甲狀腺結(jié)節(jié)診斷的薈萃分析,探討這三種檢查的診斷價(jià)值。方法：計(jì)算機(jī)檢索中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(CBM)、中國(guó)知網(wǎng)(CNKI)、 PubMed、EMBASE、Cochrane Library databases數(shù)據(jù)庫(kù),時(shí)間截至2015年2月1日。嚴(yán)格按照納入及排除標(biāo)準(zhǔn)對(duì)文獻(xiàn)進(jìn)行評(píng)價(jià)和篩選。使用Stata12.0 with Meta軟件繪制漏斗圖評(píng)價(jià)有無(wú)發(fā)表偏倚,使用meta-disc1.4軟件進(jìn)行閾值效應(yīng)檢驗(yàn)及合并分析,使用Chi-square、Cochran-Q及I-square檢驗(yàn)評(píng)價(jià)異質(zhì)性大小,通過(guò)計(jì)算加權(quán)靈敏度、特異度、陽(yáng)性似然比、陰性似然比、診斷比值比及綜合受試者綜合特征曲線(SROC)下面積(AUC),評(píng)價(jià)超聲、針吸細(xì)胞學(xué)、放射性核素掃描對(duì)于甲狀腺結(jié)節(jié)的診斷價(jià)值。結(jié)果：納入的2785例B超合并靈敏度(95%CI)為0.74(0.71-0.78),合并特異度(95%CI)為0.90(0.89-0.92),合并陽(yáng)性似然比(95%CI)為6.84(3.69-12.66),合并陰性似然比(95%CI)為0.30(0.24-0.38),合并診斷比值比(95%CI)為24.00(11.44-50.33),AUC(SE)為0.8993(0.0266)；針吸細(xì)胞學(xué)6854例,合并靈敏度(95%CI)為0.76(0.75-0.78),合并特異度(95%CI)為0.94(0.94-0.95),合并陽(yáng)性似然比(95%CI)為20.37(11.14-37.24),合并陰性似然比(95%CI)為0.24(0.15-0.38),合并診斷比值比(95%CI)為84.81(51.40-139.95),AUC(SE)為0.9583(0.0113)；放射性核素掃描(ECT)1462例,合并靈敏度(95%CI)為0.79(0.74-0.84),合并特異度(95%CI)為0.41(0.38-0.44),合并陽(yáng)性似然比(95%CI)為1.21(1.02-1.43),合并陰性似然比(95%CI)為0.59(0.35-1.01),合并診斷比值比(95%CI)為2.29(1.08-4.82),AUC(SE)為0.6342(0.0456)。結(jié)論：1、針吸細(xì)胞學(xué)檢查對(duì)甲狀腺結(jié)節(jié)的診斷價(jià)值最高,B超次之,放射性核素掃描最差；2、針吸細(xì)胞學(xué)檢查診斷甲狀腺腫瘤準(zhǔn)確度高,基本可明確甲狀腺惡性腫瘤的診斷,B超、放射性核素掃描明顯低于細(xì)針,不能依靠二者其中之一單獨(dú)確定惡性腫瘤的診斷；3、針吸細(xì)胞學(xué)檢查、B超、放射性核素掃描三者其中之一單獨(dú)的陽(yáng)性結(jié)果不能排除惡性腫瘤。
[Abstract]:Objective: to evaluate the diagnostic value of ultrasound, needle aspiration cytology and radionuclide scanning in the diagnosis of thyroid nodules. Methods: the database of Chinese biomedical literature was searched by computer. The database of Chinese biomedical literature (CBM), CNKI (China) and PubMedus (EMBASE) Cochrane Library (databases) were searched as of Feb 1, 2015. To evaluate and screen the literature strictly according to the criteria of inclusion and exclusion. Using Stata12.0 with Meta software to draw funnel chart to evaluate whether there is publication bias, using meta-disc1.4 software to test threshold effect and combining analysis, using Chi-square-Cochran-Q and I-square test to evaluate heterogeneity, calculating weighted sensitivity, specificity, positive likelihood ratio, and then using Chi-square-Cochran-Q and I-square test to evaluate heterogeneity. The negative likelihood ratio, diagnostic ratio and the area under the synthetic characteristic curve of SROC were evaluated to evaluate the diagnostic value of ultrasound, needle aspiration cytology and radionuclide scanning in thyroid nodules. Results: the sensitivity (95 CI) of 2785 cases with B-ultrasound was 0.740.71 -0.78, the combined specificity was 0.90 ~ 0.992, the positive likelihood ratio was 6.84 ~ 3.69-12.66, the negative likelihood ratio was 0.300.24-0.38, the combined diagnostic ratio was 24.000.11.44-50.33AUCSE0.89930.0266and the needle aspiration cytology 6854 cases, the combined diagnostic ratio was 24.0011.44-50.33AUCSE0.8993a 0.0266a, the negative likelihood ratio was 0.300.24-0.38, the combined diagnostic ratio was 24.000.11.44-50.33AUCSE0.966.The positive likelihood ratio was 6.84v 3.69-12.66%, the negative likelihood ratio was 0.300.24-0.38%, the combined diagnostic ratio was 24.0011.44-50.333AUCSE0.89930.266. The combined sensitivity was 0.760.5-0.78, the combined specificity was 0.94-0.95, the positive likelihood ratio was 20.3711.14-37.24, the combined negative likelihood ratio was 0.240.15-0.38, the combined diagnostic ratio was 84.81% (51.40-139.95 CI), the positive likelihood ratio was 0.958 3 ~ 0.0113, the combined likelihood ratio was 0.24 ~ 0.15-0.38, and the combined diagnostic ratio was 84.81% 51.40-139.95% AUCSE. The combined sensitivity was 0.790.74 ~ 0.84, the combined specificity was 0.41 ~ 0.38-0.44, the combined positive likelihood ratio was 1.21 ~ 1.02-1.43, the combined negative likelihood ratio was 0.590.35-1.01and the combined diagnostic ratio was 2.29 ~ 1.08-4.82AUCSE= 0.63420.0456. Conclusion the diagnostic value of needle aspiration cytology for thyroid nodule is the highest, followed by B ultrasound, and radionuclide scanning is the worst. The accuracy of needle aspiration cytology in the diagnosis of thyroid neoplasms is high. The radionuclide scan was obviously lower than that of the fine needle. The diagnosis of malignant tumor could not be determined separately by one of them. The positive results of one of them could not exclude the malignant tumor, such as needle aspiration cytology, B-ultrasound and radionuclide scanning.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R581

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本文編號(hào)：1985071