目的:胡桃夹综合征(NCS)可由肠系膜上动脉(SMA)角度狭窄引起。然而,SMA角度的截止值是有争议和可变的。因此,本研究通过荟萃分析评估了最佳SMA角度,以最大限度地提高NCS诊断的诊断性能.
方法:我们从SMA的角度(从数据库建立之日起至2022年6月)全面搜索了与NCS诊断相关的英文文献。通过计算合并灵敏度(SEN)评估SMA角度小于41°的NCS诊断的准确性,汇集特异性(SPE),正似然比(LR+),负似然比(LR-),总结受试者工作特征(SROC)曲线和曲线下面积(AUC)值。采用I2检验和荟萃回归分析评估异质性和异质性来源,分别。使用Deeks漏斗图不对称检验评估发表偏倚。
结果:六项研究(526例患者)符合纳入标准。SEN和SPE分别为0.94(95%置信区间(CI)0.80-0.99)和0.85(95%CI0.65-0.94),分别。LR+值为6.0,而LR-值为0.07,表明小于41°的SMA角度表现出极好的帮助确认或排除NCS的能力。此外,SROC曲线显示,小于41°的SMA角度诊断NCS的AUC为0.96,表明小于41°的SMA角度有助于诊断NCS具有良好的疗效。
结论:本研究通过荟萃分析探讨了SMA角截断值的诊断效能。根据高SPE和SEN结果,小于41°的SMA角度在促进NCS诊断方面具有良好的功效。
OBJECTIVE: Nutcracker syndrome (NCS) can be caused by narrowness of the superior mesenteric artery (SMA) angle. Nevertheless, the cut-off value of the SMA angle is controversial and variable. Therefore, the present study evaluated the optimal SMA angle to maximize diagnostic performance for NCS diagnosis by conducting a meta-analysis.
METHODS: We comprehensively searched the English literature related to the diagnosis of NCS from the perspective of SMA (from the date of database inception to June 2022). The accuracy of an SMA angle less than 41° in the diagnosis of NCS was evaluated by calculating the pooled sensitivity (SEN), pooled specificity (SPE), positive likelihood ratio (LR+), negative likelihood ratio (LR-), summary receiver operating characteristic (SROC) curve and area under the curve (AUC) value. The I2 test and meta-regression analysis were used to assess heterogeneity and sources of heterogeneity, respectively. Publication bias was assessed using Deeks\' funnel plot asymmetry test.
RESULTS: Six studies (526 patients) met the inclusion criteria. SEN and SPE were 0.94 (95% confidence interval (CI) 0.80-0.99) and 0.85 (95% CI 0.65-0.94), respectively. The LR + value was 6.0, and the LR- value was 0.07, revealing that SMA angles less than 41° exhibited an excellent ability to help confirm or exclude NCS. Additionally, SROC curves showed that the AUC of SMA angles less than 41° for the diagnosis of NCS was 0.96, indicating that SMA angles less than 41° have good efficacy for helping to diagnose NCS.
CONCLUSIONS: This study explored the diagnostic efficacy of the cut-off value of the SMA angle by meta-analysis. According to the high SPE and SEN results, SMA angles less than 41° have good efficacy in facilitating NCS diagnosis.