用于肝硬化患者胃食管静脉曲张诊断和风险评估的计算机断层扫描：系统回顾和荟萃分析。

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY Accounts of Chemical Research Pub Date : 2024-11-06 Epub Date: 2024-05-20 DOI:10.4274/dir.2024.242723

Jinkui Li, Yuanhui Zhu, Jinrong Ni, Lili Wang, Junqiang Lei

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引用次数: 0

摘要

目的：本荟萃分析旨在评估计算机断层扫描（CT）对胃食管静脉曲张（GEVs）的诊断准确性，并识别肝硬化患者中的高危GEVs：方法：通过对数据库进行全面检索，发现了28项研究报告了通过内镜检查确诊的胃食管静脉曲张的CT诊断结果。进行了元分析以计算集合敏感性（SEN）和集合特异性（SPE）、阳性似然比（PLR）和阴性似然比（NLR）、诊断几率比（DOR）和曲线下面积（AUC）：根据患者（或静脉曲张）人数，基于 CT 诊断的汇总 SEN、SPE、PLR、NLR、DOR 和 AUC 分别估计为 0.91 (0.92)、0.81 (0.45)、4.82 (1.67)、0.11 (0.17)、42.47 (10.26), and 0.93 (0.94), respectively for any GEVs and at 0.89 (0.89), 0.90 (0.79), 8.86 (4.28), 0.12 (0.14), 75.71 (30.19), and 0.95 (0.85), for high-risk GEVs.亚组分析表明，与胃静脉曲张相比，CT 对食管静脉曲张的诊断准确率更高（AUC：0.93 对 0.89，P＜0.05），与 16 层 CT 相比，64 层 CT 的 SEN 更优，P＜0.05）。与回顾性研究相比，前瞻性研究显示出更高的诊断准确性（AUC：0.95 vs. 0.90，P < 0.05）。关于静脉曲张的大小，3 毫米和 5 毫米的临界值分别可区分低危和高危人群，诊断准确率较高（AUC：0.992 vs. 0.997，P > 0.05）：结论：CT 在识别肝硬化患者的静脉曲张和区分高危静脉曲张方面具有良好的诊断准确性。有必要进一步研究验证最佳的静脉曲张大小临界值，以提高临床实用性：CT扫描预测静脉曲张的诊断准确率如此之高，对于伴有门脉高压的肝硬化患者来说具有重要的临床意义。如果 CT 扫描发现了高危静脉曲张，早期干预将有助于降低静脉曲张出血的风险。

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Computed tomography for the diagnosis of gastroesophageal varices and risk assessment in patients with cirrhosis: a systematic review and meta-analysis

Purpose: This meta-analysis aimed to evaluate the diagnostic accuracy of computed tomography (CT) for detecting gastroesophageal varices (GEVs) and identify high-risk GEVs in patients with cirrhosis.

Methods: A comprehensive search of databases identified 28 studies reporting on CT-based diagnosis for GEVs confirmed via endoscopy. Meta-analyses were conducted to calculate pooled sensitivity (SEN) and pooled specificity (SPE), positive likelihood ratio (PLR) and negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the area under the curve (AUC).

Results: Based on the number of patients (or varices), the pooled SEN, SPE, PLR, NLR, DOR, and AUC of CT-based diagnosis were estimated at 0.91 (0.92), 0.81 (0.45), 4.82 (1.67), 0.11 (0.17), 42.47 (10.26), and 0.93 (0.94), respectively, for any GEV and at 0.89 (0.89), 0.90 (0.79), 8.86 (4.28), 0.12 (0.14), 75.71 (30.19), and 0.95 (0.85), respectively, for high-risk GEVs. Subgroup analyses indicated that CT had a higher diagnostic accuracy for esophageal varices compared with gastric varices (AUC: 0.93 vs. 0.89, P < 0.05), and the 64-slice CT yielded superior SEN compared with 16-slice and <16-slice CT (AUC: 0.97 vs. 0.92 and 0.82, respectively, P < 0.05). Prospective studies demonstrated higher diagnostic accuracy than retrospective studies (AUC: 0.95 vs. 0.90, P < 0.05). Regarding variceal size, a cut-off of 3 mm and 5 mm discriminated between low- and high-risk individuals, respectively, with high diagnostic accuracy (AUC: 0.992 vs. 0.997, P > 0.05).

Conclusion: CT demonstrates promising diagnostic accuracy for identifying gastroesophageal varices and distinguishing high-risk GEVs in patients with cirrhosis. Further research to validate optimal variceal size cut-offs is warranted to enhance clinical utility.

Clinical significance: Such a high diagnostic accuracy of CT scans for predicting varices is clinically meaningful for patients with cirrhosis accompanied by portal hypertension. If high-risk varices are identified at CT scans, early intervention would be helpful to reduce the risk of variceal bleeding.

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.