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腹部超声对新生儿坏死性小肠结肠炎手术时机预测价值的Meta分析
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Abstract:
目的：本研究系统评价腹部超声(Abdominal Ultrasound, AUS)对新生儿坏死性小肠结肠炎(Necrotizing Enterocolitis, NEC)手术时机的预测价值，为临床决策提供参考。方法：本研究采用系统性文献检索的方法，整合中英文学术资源，包括中国知网、万方数据库、PubMed、Medline、Embase、Web of Science和Cochrane Library，涵盖各数据库自建库至2024年7月期间发表的相关研究。研究聚焦AUS对NEC手术时机预测价值的研究，通过纳入及排除标准筛选合格的文献，采用修订版诊断性研究质量评估量表(Quality Assessment of Diagnostic-2, QUADAS-2)对入选文献质量进行评价。运用Stata 16.0统计软件进行Meta分析，主要评估指标包括敏感度(Sensitivity, SEN)、特异度(Specificity, SPE)，同时绘制汇总受试者工作特征曲线(SROC)下面积(AUC)量化预测效能。结果：本次研究最终筛选出了12篇文献，共1158例患者。最终得出AUS对NEC手术时机预测的SEN合并为0.89 [95% CI 0.84, 0.93]，SPE合并为0.76 [95% CI 0.69, 0.81]，PLR为3.71 [95% CI 2.92, 4.73]；NLR为0.14 [95% CI 0.10, 0.21]，SROC曲线下面积AUC为0.90 [95% CI 0.87, 0.92]。结论：AUS对NEC手术时机有一定的预测价值，可以改善NEC患者的转归及预后，值得临床推广。
Objective: This study systematically evaluated the predictive value of abdominal ultrasound (AUS) for the surgical timing of NEC to provide reference for clinical decision-making. Methods: In this study, a systematic literature was used to integrate Chinese and English academic resources, including CNKI, Wanfang database, PubMed, Medline, Embase, Web of Science and Cochrane Library, including relevant studies published up to July 2024. This study focused on the predictive value of AUS for NEC surgery timing. Qualified literatures were screened by inclusion and exclusion criteria, and the Quality of the selected literatures was evaluated using the quality assessment of diagnostic accuracy studies-2 (QUADAS-2). Stata 16.0 statistical software was used for the Meta analysis, the main indicators included sensitivity (SEN) and specificity (SPE), and the area under the ROC curve of the summary receiver operating characteristic curve (SROC). Results: A total of 12 studies involving 1158 patients were finally included. The combined sensitivity of ultrasound for predicting the surgical timing of NEC was 0.89 [95% CI 0.84, 0.93], the combined specificity was 0.76 [95% CI 0.69, 0.81], the positive likelihood ratio was 3.71 [95% CI 2.92, 4.73], the negative likelihood ratio was 0.14 [95% CI 0.10, 0.21], and the AUC of the SROC curve was 0.90 [95% CI 0.87, 0.92]. Conclusion: AUS has certain predictive value for the timing of surgery in NEC, which can improve the prognosis and outcome of NEC patients and is worthy of clinical promotion.
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