PDF(Pubmed)
Abstract：
Background: Inflammatory bowel disease (IBD) consists of Crohn\'s disease (CD) and Ulcerative colitis (UC). The main goal of treatment is to obtain mucosal healing via endoscopy. More recently, intestinal ultrasounds, along with biochemical markers, have been increasingly popular as point-of-care testing to monitor treatment response. This systemic review and meta-analysis aimed to assess the diagnostic test performance of ultrasonography and biochemical markers (C-reactive protein and fecal calprotectin) compared with endoscopy for detecting inflammation in IBD. Methods: A comprehensive literature search was conducted using PubMed Medline, EMBASE, ScienceDirect, and CINAHL from 1 January 2018 to 1 January 2024. The included studies were prospective and retrospective observational studies, clinical trials, and cross-sectional studies investigating the diagnostic sensitivity and specificity of ultrasonography, biochemical markers, and endoscopy. Studies were selected based on the Preferred Reporting Items for Systematic Review and Meta-analysis Statement (PRISMA). Results: Of the 1035 studies retrieved, 16 met the inclusion criteria, and most of the included studies were prospective observational studies. Diagnostic test accuracy was conducted, and the pooled sensitivity and specificity of all the studies revealed that ultrasonography has the highest pooled sensitivity, at 85% (95% CI, 78 to 91%), and specificity, at 92% (95% CI, 86 to 96%), as compared with biochemical markers and endoscopy. More specifically, biochemical markers had a pooled sensitivity and specificity of 85% (95% CI, 81 to 87%) and 61% (95% CI, 58 to 64%), respectively, and endoscopy had 60% (95% CI, 52 to 68%) and 82% (95% CI, 76 to 87%), respectively. However, the results also show substantial heterogeneity in the studies because of various populations, protocols, and outcomes in the studies included. This was especially noted in the assessment of biochemical markers, in which a metaregression was performed showing a nonsignificant p-value of 0.8856 for the coefficient. Conclusions: IUS was found to have the highest pooled sensitivity and specificity of all the included studies for diagnosing inflammation in patients with CD and UC, and this, coupled with biochemical markers, can improve diagnostic utility.
摘要：
背景：炎症性肠病（IBD）包括克罗恩病（CD）和溃疡性结肠炎（UC）。治疗的主要目标是通过内窥镜检查获得粘膜愈合。最近,肠道超声，连同生化标记物,作为监测治疗反应的即时检测越来越受欢迎。这项系统综述和荟萃分析旨在评估超声检查和生化标志物（C反应蛋白和粪便钙卫蛋白）与内窥镜检查检测IBD炎症的诊断测试性能。方法：使用PubMedMedline进行全面的文献检索，EMBASE,ScienceDirect,和CINAHL从2018年1月1日至2024年1月1日。纳入的研究是前瞻性和回顾性观察性研究，临床试验,和横断面研究调查超声诊断的敏感性和特异性，生化标志物,和内窥镜检查。根据系统评价和荟萃分析声明（PRISMA）的首选报告项目选择研究。结果：在检索到的1035项研究中，16符合纳入标准，纳入的研究大多为前瞻性观察性研究.进行诊断测试的准确性，所有研究的合并敏感性和特异性表明，超声检查具有最高的合并敏感性，85%（95%CI，78%至91%），和特异性，92%（95%CI，86至96%），与生化标志物和内窥镜检查相比。更具体地说,生化标志物的合并敏感性和特异性分别为85%(95%CI，81-87%)和61%(95%CI，58-64%)，分别,内窥镜检查有60%（95%CI，52-68%）和82%（95%CI，76-87%），分别。然而,结果还显示，由于不同的人群，研究中存在很大的异质性，协议,研究结果包括。这在生化标志物的评估中尤其值得注意，其中进行了回归，显示系数的无显著p值为0.8856。结论：在所有纳入的CD和UC患者的炎症诊断研究中，IUS具有最高的合并敏感性和特异性。而这个,加上生化标记，可以提高诊断效用。
