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缺铁性贫血患者小肠胶囊内窥镜的诊断率:系统回顾

发布日期:2014-1-29 12:40:55 文章来源:GIE 作者次数:1565
    缺铁性贫血患者小肠胶囊内窥镜的诊断率:系统回顾

    背景

    缺铁性贫血IDA是全球最常见的贫血。目前有指南建议缺铁性贫血患者应使用小肠胶囊内镜SBCE。但针对SBCE对仅有IDA的患者的治疗有效性,证据有限。

    目的

    通过汇集相关研究数据评估IDA患者的SBCE诊断率(DY)

    设计

    系统回顾和荟萃分析。酌情使用固定效应模型或随机效应模型。

    环境

    估计SCBEIDA 患者的诊断率的相关研究被确定。两位研究人员单独进行搜索和数据提取。

    患者

    共实施24项研究,纳入1960IDA患者,这些患者接受了SBCE

    主要测量指标

    对每例患者的诊断率,95%置信区间。同时也开展了亚组分析。

    结果

    通过随机效应模型评估,SBCEIDA患者的汇集诊断率为47%95%可信区间:42% - -52%但是各研究之间不一致性指数[I2]= 78.8%P <0 .0001存在显著的差异,有统计学意义。在仅集中在IDA患者的研究14子集研究中,SBCE的汇集诊断率66.6%95%可信区间61.0% - 72.3%I2 = 44.3%);相反,在不单只集中在IDA患者的研究220子集研究中,其汇集诊断率为为44%95%可信区间39% - -48%; I2 = 64.9%。特别是, 对参与子集1研究中的患者,SBCE检测出更多的血管(31% 22.6%P = .007)炎症17.8% 11.3%P =0 .009和肿块/肿瘤7.95% vs 2.25%P <0.0001病变。

    局限性

    研究异质性,回顾性设计和选择性偏差

    结论

    该分析表明了SBCEIDA患者的有效性,也显示出对之前诊断检查的负面影响,尽管还应考虑某些因素如异质性和纳入研究的质量。

    缩写词:CI置信区间DY诊断率FOBT,粪便潜血检查;Hb血红蛋白I2,不一致性指数;IDA,缺铁性贫血;OGIB,隐性消化道出血;QUADAS,诊断准确率研究的质量评价;SBCE小肠胶囊内窥镜.

     


    Diagnostic yield of small-bowel capsule endoscopy in patients with iron-deficiency anemia: a systematic review

    Background

    Iron-deficiency anemia (IDA) is the most common cause of anemia worldwide. Current guidelines recommend the use of small-bowel capsule endoscopy (SBCE) in IDA. Evidence of the validity of SBCE in patients with IDA alone is still limited.

    Objective

    To assess the diagnostic yield (DY) of SBCE in IDA by pooling data from relevant studies.

    Design

    Systematic review and meta-analysis. Fixed-effects or random-effects models were used as appropriate.

    SettingStudies that estimated the DY of SCBE in IDA were identified. Two investigators independently conducted the search and data extraction.

    Patients

    A total of 24 studies enrolling 1960 patients with IDA who underwent SBCE were included.

    Main Outcome Measurements

    Per-patient DY, with 95% confidence intervals. Subgroup analysis was also performed.

    ResultsThe pooled DY of SBCE in IDA, evaluated by a random-effects model, was 47% (95% CI, 42%-52%), but there was statistically significant heterogeneity among the included studies (inconsistency index [I2] = 78.8%, P < .0001). The pooled DY of SBCE in studies focused solely on patients with IDA (subset 1, 4 studies) was 66.6% (95% CI, 61.0%-72.3%; I2 = 44.3%); conversely, that of studies not focusing only on IDA patients (subset 2, 20 studies) was 44% (95% CI, 39%-48%; I2 = 64.9%). In particular, more vascular (31% vs 22.6%, P = .007), inflammatory (17.8% vs 11.3%, P = .009), and mass/tumor (7.95% vs 2.25%, P < .0001) lesions were detected with SBCE in patients participating in the studies in subset 1.

    Limitations

    Heterogeneity of studies, retrospective design, and selection bias.

    Conclusions

    This analysis demonstrates the validity of SBCE in the investigation of patients with IDA and negative findings on a previous diagnostic workup, although certain factors such as heterogeneity and quality of the included studies should be taken into account.

    Abbreviations:  CI, confidence interval, DY, diagnostic yield, FOBT, fecal occult blood test, Hb, hemoglobin, I2, inconsistency index, IDA, iron-deficiency anemia, OGIB, obscure GI bleeding, QUADAS, Quality Assessment of Diagnostic Accuracy Studies, SBCE, small-bowel capsule endoscopy.

     

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