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内镜检查在判断嗜酸细胞性食管炎的患病率以及诊断中的作用:一项荟萃分析

发布日期:2015-7-21 13:58:16 文章来源:医脉通 作者次数:873

     内镜对嗜酸细胞性食管炎的诊断价值不足

    北卡罗来纳大学食管疾病与吞咽中心的Hannah P. Kim及其同事在9月刊《临床胃肠病学与肝病学》杂志上发表文章称,仅凭内镜检查中的发现既不足以诊断嗜酸细胞性食管炎(EoE),也不能断定是否应进行活检。

    Kim 等人对PubMed 、EMBASE和消化会议中的80篇文章和20篇摘要进行了Meta分析,共涉及4,678例EoE患者和2,742名非EoE的对照者。所有入选的研究均纳入至少10例EoE患者,并且能提供相关内镜检查结果的信息。各项研究受试者的平均年龄为6~55岁不等。

    作者在分析中发现,总体样本中的食管环流行率为44%,食管狭窄流行率为21%,线状沟流行率为48%。观察发现食管内径狭窄的汇总流行率仅为9%,食管白斑或渗出的流行率为 27%。41%的患者在内镜下肉眼观察到苍白或血管减少,17%观察到侵蚀性食管炎。“17%的病例内镜检查结果正常。”

    作者还发现,上述内镜下表现的流行情况因患者年龄而不同。例如,食管环和食管狭窄在成人中比在儿童中更多见(分别为57% vs. 11%和25% vs. 8%;均P<0.05)。而白斑和苍白/血管减少在儿童中比在成人中更常见(分别为36% vs. 19%和58% vs. 18%;均P<0.05)。

            作者还评估了每种内镜下表现的总体敏感性、特异性、汇总阳性预测值(PPV)和阴性预测值(NPV)。结果显示,食管环的这4项指标分别为48%、91%、 64%和84%;食管狭窄分别为15%、95%、51%和76%;“线状沟的操作特征略好一些”,分别为40%、95%、73%和83%;苍白和(或)血管减少分别为43%、90%、65%和79%。与单项内镜下表现敏感性低不同的是,如果有1项以上的内镜下异常发现,敏感性增至87%,特异性为 47,PPV和NPV分别为42%和89%。

    “尽管食管环、线状沟、白斑或渗出等内镜下表现被认为是EoE的典型特征,但内镜医师并不是总能识别出这些表现。而且尽管上消化道内镜检查在绝大多数EoE患者中都能有所发现,但单项表现的敏感性较低,即使特异性较高,最后得到的预测值仍不足以达到诊断目的。因此,不论内镜下有无特殊发现,凡是有EoE症状的患者均应接受食管活检。”

    摘要

    BACKGROUND & AIMS:Endoscopic findings such as esophageal rings, strictures, narrow-caliber esophagus, linear furrows, white plaques, and pallor or decreased vasculature might indicate the presence of eosinophilic esophagitis (EoE). We aimed to determine the prevalence and diagnostic utility of endoscopic features of EoE.

    METHODS:We conducted a systematic review and meta-analysis. PubMed, EMBASE, and gastrointestinal meeting abstracts were searched to identify studies that included more than 10 patients with EoE and reported endoscopic findings. Pooled prevalence, sensitivity, specificity, and predictive values were calculated using random- and mixed-effects models.

    RESULTS:The search yielded 100 articles and abstracts on 4678 patients with EoE and 2742 without (controls). In subjects with EoE, the overall pooled prevalence was as follows: esophageal rings, 44%; strictures, 21%; narrow-caliber esophagus, 9%; linear furrows, 48%; white plaques, 27%; and pallor/decreased vasculature, 41%. Substantial heterogeneity existed among studies. Results from endoscopy examinations were normal in 17% of patients, but this number decreased to 7% when the analysis was limited to prospective studies (P < .05). Overall levels of sensitivity were modest, ranging from 15% to 48%, whereas levels of specificity were greater, ranging from 90% to 95%. Positive predictive values ranged from 51% to 73% and negative predictive values ranged from 74% to 84%.

    CONCLUSIONS:There is heterogeneity among studies in the reported prevalence of endoscopic findings in patients with EoE, but in prospective studies at least 1 abnormality was detected by endoscopy in 93% of patients. The operating characteristics of endoscopic findings alone are inadequate for diagnosis of EoE. Esophageal biopsy specimens should be obtained from all patients with clinical features of EoE, regardless of the endoscopic appearance of the esophagus.

     

     

    译者:tianyi11

     

     

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