CAJ | 학술논문

目的系统评价超声诊断深部浸润型子宫内膜异位症(内异症)文献的质量,并荟萃分析超声检查对深部浸润犁内异症病灶诊断的准确性.方法采用计算机和手工检索方法,全面收集1966-2009年关于深部浸润型内异症的超声检查诊断性试验的文献,并根据诊断准确性研究的质量评价量表(QUADAS)评价符合纳入标准的文献质量,用Meta-disc软件对直肠超声(TRUS)、阴道超声(TVUS)、直肠内镜超声(EUS)的敏感性、特异性、阳性似然比(+LR)、阴性似然比(-LR)、诊断性试验比值比(DOR)等进行合并分析和异质性检验,对无异质性的文献绘制综合受试者工作特征(SROC)曲线.结果共纳入符合标准的文献15篇,均为英文文献.QUADAS中有10项条目的符合率均超过60%;第11项条目"是否是在不知道待评价试验的结果下进行参考标准结果的判读"的符合率为46.7%(7/15);无一篇研究报道了第13项条目"是否报道了无法解释和(或)中间试验的结果".通过阈值效应分析没有发现研究的异质性.TRUS的敏感度、特异度、+LR、-LR、DOR分别为0.925、0.986、30.036、0.107、299.25;TVUS为0.799、0.944、11.972、0.187、69.126;EUS为0.635、0.928、8.022、0.320、39.606;EUS的SROC曲线下面积为0.9479,略高于TVUS的0.9246.结论 TRUS、TVUS和EUS均显示了对深部浸润型内异症较好的诊断价值.本系统评价所纳入15篇文献的偏倚主要来自参考标准判读时未实施盲法,存在变异的可能性较大.
목적 계통평개초성진단심부침윤형자궁내막이위증(내이증)문헌적질량,병회췌분석초성검사대심부침윤리내이증병조진단적준학성.방법 채용계산궤화수공검색방법,전면수집1966-2009년관우심부침윤형내이증적초성검사진단성시험적문헌,병근거진단준학성연구적질량평개량표(QUADAS)평개부합납입표준적문헌질량,용Meta-disc연건대직장초성(TRUS)、음도초성(TVUS)、직장내경초성(EUS)적민감성、특이성、양성사연비(+LR)、음성사연비(-LR)、진단성시험비치비(DOR)등진행합병분석화이질성검험,대무이질성적문헌회제종합수시자공작특정(SROC)곡선.결과 공납입부합표준적문헌15편,균위영문문헌.QUADAS중유10항조목적 부합솔균초과60%;제11항조목"시부시재불지도대평개시험적결과하진행삼고표준결과적판독"적부합솔위46.7%(7/15);무일편연구보도료제13항조목"시부보도료무법해석화(혹)중간시험적결과".통과역치효응분석몰유발현연구적이질성.TRUS적민감도、특이도、+LR、-LR、DOR분별위0.925、0.986、30.036、0.107、299.25;TVUS위0.799、0.944、11.972、0.187、69.126;EUS위0.635、0.928、8.022、0.320、39.606;EUS적SROC곡선하면적위0.9479,략고우TVUS적0.9246.결론 TRUS、TVUS화EUS균현시료대심부침윤형내이증교호적진단개치.본계통평개소납입15편문헌적편의주요래자삼고표준판독시미실시맹법,존재변이적가능성교대.
Objective To evaluate the quality of literatures and the accuracy of ultrasonography in diagnosis of deeply infiltrating endometriosis(DIE).Methods The database of Medline (1966 to 2009), the excerpta medica database (EMBASE, 1980 to 2009), Chinese biological medicine on disc (CBMdisc, 1978 to 2009), China national knowledge infrastructure (CNKI, 1979 to 2009) and VIP for Chinese technology periodical database (VIP, 1989 to 2009) Cochrane library of studies about the diagnosis of ultrasound for DIE were searched and analyzed.Quality assessment of diagnostic accuracy studies (QUADAS) items were used to evaluate the quality of literatures.The sensitivity, specificity, positive likelihood ratio(+ LR), negative likelihood ratio (-LR) ,diagnostic test odds ratio (DOR) for the pooled analysis and heterogeneity test were analyzed for transvaginal ultrasonography(TVUS), transrectal ultrasonography (TRUS) and rectal endoscopic sonography(EUS) by Meta-disc software, and drew the summary receiver operating characteristic (SROC) curves for those without heterogeneity.Results Totally 15 literatures in English were enrolled into this study.The positive rate of 10 items of QUADAS were above 60%, whereas that of the 11th item "Were the reference standard results interpreted without knowledge of the results of the index test" was 46.7% ;none of studies had mentioned the 13th item " Were uninterpretable/intermediate test results reported".All researches had no heterogeneity by explored threshold effect.The results of pooled sensitivity, specificity, + LR, - LR, DOR were 0.925,0.986, 30.036,0.107, 299.25 for TRUS, 0.799,0.944,11.972,0.187, 69.126 for transvaginal ultrasonography (TVUS), and 0.635,0.928,8.022, O.320, 39.606 for EUS, respectively.Area under the curve of EUS was 0.9479, and that of TVUS was 0.9246.Conclusions TRUS,TVUS and EUS all showed optimal value in diagnosis of DIE.The bias identified from the 15 studies might be mainly resulted from reference standard review bias.